Archive for April, 2017

Health Insurance is NOT Health Care

Tuesday, April 25th, 2017

evans

I’ve said for years that one of the main reasons ObamaCare passed was because they did a great job of confusing Health Insurance with Healthcare financing, or Healthcare.  I recently ran across the attached article that does a great job of addressing this point and wanted to share it.  I hope you enjoy it as much as I did.

Have a great day!   Jeff Evans, Director, Benefit Services jevans@healthplan.org

(more…)

Craig Lack – “The Most Effective Consultant You Never Heard Of”

Monday, April 24th, 2017

coolaid

Craig Lack is “the most effective consultant you’ve never heard of,” according to Inc. magazine. He consults nationwide with C-suites and independent healthcare broker consultants to eliminate employee out-of-pocket expenses, predictably lower healthcare claims and drive substantial revenue.

(more…)

5 Biggest Mistakes CFOs Make When Buying Healthcare

Sunday, April 23rd, 2017

ifix

Most CFOs don’t know whether their company’s medical plan pays retail, wholesale or institutional charges.

(more…)

AMPS Announces Investment to Continue Rapid Growth

Saturday, April 22nd, 2017

AMPS_Blue111

“Last year AMPS grew by over 70% and we are on a financial track to do the same this year,” said Dendy.  “However, beyond financing, we also see the new investors as an opportunity to build and expand our leadership footprint in healthcare cost management services for employers, health care plans, and government entities.”

(more…)

Price Transparency App For Diminishing Middle Class

Saturday, April 22nd, 2017

transparencyiiii“Household salaries have remained flat over the past 20-plus years as every potential salary raise is applied to feed the healthcare beast…………”

(more…)

Beating Medical Trend

Saturday, April 22nd, 2017

arrow

Medical inflation continues to rise at a rate above the growth rate in the economy. Facing rate increases year after year, plan sponsors, with their financial backs to the wall, have historically resorted to cost shifting. These continued failed attempts to control costs have […]

(more…)

Robbing Peter To Pay Paul

Friday, April 21st, 2017

peter

The risk-adjustment program program is supposed to protect plans from covering more than their fair share of sick enrollees. Program managers at CCIIO take cash from plans with low-risk enrollees and send the cash to plans with high-risk enrollees.

(more…)

TPA Lesson 101 – How To Be Sneaky & Always Be”Lowest Bidder”

Thursday, April 20th, 2017

mulebriar

Our website (www.mollymulebriar.orggets emails from time to time through our Tip Line exposing industry secrets……

(more…)

How Drug-Company ‘Benevolence’ Silences the Sick

Thursday, April 20th, 2017

outrageous12

For decades, the price of Syprine was $1 per 250-milligram tablet, or about $1,460 a year………. Today, Valeant charges around $300,000 for a year’s worth of Syprine…………

(more…)

Is Direct Contracting the Right Strategy for Your Organization?

Thursday, April 20th, 2017

mulebriarConnect with employer and provider peers who are actually developing and strengthening direct contracting relationships to discuss the pros and cons of direct contracting at the 3rd Annual Employer-Health System Direct Contracting & Partnership Strategies Summit on July 25 in Boston.  Gain insights into such questions as:

(more…)

Amazing: Nostradamus Predicts TRS ActiveCare Future

Wednesday, April 19th, 2017

nostr

An amazing discovery, an ancient manuscript found yesterday by Waring, Texas Girl Scout Troop 34, buried near an oak tree on the grounds of the Texas state capitol is purported to be one of the missing chapters in famed Nostradamus book “The Future of Government Health Care in Tejas.”

(more…)

How Does Your Stop Loss Premiums Compare To The Market?

Monday, April 17th, 2017

stoplossinsuranceHow does your current stop loss policy premiums compare to the market? Aegis Risk’s premium survey provides average industry benchmarks…………………..

(more…)

Do Fee Based Consultants Earn Kickbacks From Carriers They Recommend?

Saturday, April 15th, 2017

dontt

One of the best kept secrets of the insurance industry is the practice of paying kickbacks to insurance consultants which are never disclosed to clients who pay them.

(more…)

RiskManagers.us Offers Post Graduate Course For Plan Sponsors

Friday, April 14th, 2017

classroom

If you wish to continue operating your self-funded plan the old fashion way this advanced course will not be of interest to you – Homer G. Farnsworth, PHD

(more…)

Protection Money In Health Care

Thursday, April 13th, 2017

godfather

Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices.

(more…)

Games Brokers Play – A True Story

Wednesday, April 12th, 2017

mulebriar

“Those who have data win. Those who have good data win a lot. Those who have real time data win all the time” 

 

(more…)

Texas Feeding Frenzy Begins…………

Monday, April 10th, 2017

sharkfeeding

Texas Senate Bill 789, which will gut the TRS ActiveCare health plan for Texas school districts, will pass according to our sources in Austin. (The Coming Implosion of TRS ActiveCare?The next 14 days will tell the story.

(more…)

AMPS

Monday, April 10th, 2017

AMPS_Blue111“Over the last 3 years, AMPS average reimbursement level on hospital claims has averaged 156% of Medicare or approximately 37% less than PPO reimbursement levels. For every 1,000 employees on an employers’ health plan, this 37% decrease in cost equates to approximately $2,550,000 in savings.” 

(more…)

Klepper’s Blog – A Resource Center For Employer & Union Purchasers

Sunday, April 9th, 2017

klepper

Brian Klepper

I’ve decided to reconstitute my blog, Care & Cost, to be more inclusive again of other writers, and to focus on purchaser issues.

(more…)

Question for Hospital Administrators

Sunday, April 9th, 2017

question1

It is no secret in our industry what plan sponsors pay towards patient advocacy, balance billing defense and legal defense. I am positive you know too.

(more…)

Second Opinion From Doctor Nets Different Diagnosis 88% Of Time, Study Finds

Sunday, April 9th, 2017

ohno

A new study finds that 88% of people who go for a second opinion after seeing a doctor wind up receiving a refined or new diagnosis.

(more…)

Stop Overpaying For Healthcare

Sunday, April 9th, 2017

pricetoohigh

“We are building an army of volunteer attorneys prepared to represent people when the time comes. In fact, when communicating with providers and bill collectors, we’ve been asking them to sue the patient. Thus far, none have.” – David Silverstein

(more…)

Hospital Knows How To Play The System – Turning Cost Sharing Plans Into 100% Plans

Saturday, April 8th, 2017

winkHospital system knows how to turn cost sharing health plans into 100% plans, much to the delight of plan members…………….

(more…)

House Passes Stop-Loss Definition Bill by Huge Margin

Wednesday, April 5th, 2017

wowThe bill, H.R. 1304, would block federal efforts to regulate small stop-loss plans as health insurance by excluding the plans from the federal definition of “health insurance coverage.”

(more…)

How To Fight Unfair Hospital Billing – Deny Payment & Dispute Bill

Wednesday, April 5th, 2017

silverstein

David Silverstein –  www.BrokenHealthCare.org

Broken Health.org’s system of fighting unfair hospital billing is centered on “Denial of Payment.”

(more…)

Texas Legislature To Tackle Balance Billing Issues – Jeff Evans Opines……….

Tuesday, April 4th, 2017

evans

As a citizen of the great state of Texas, I am curious about the introduction of several bills designed to “ensure health plans are discouraged from underpaying providers.” – Jeff Evans

To Jeff’s point, David Silverstien addresses a basic problem with government interference in our health care system:

“We recommend extensive legislative education. We genuinely believe that legislators do not understand the true nature of healthcare pricing and that, as the paramount issue of our time, they must. Our form of government is grounded in the expectation that the citizenry elect wise and noble people who then study the issues before them to an extent not possible by the general public. The nature of healthcare pricing is such that the limited knowledge of legislators is approaching the danger level.” – David Silverstien

(more…)

Government Continues To Interfere With Free Market Despite Republican Pledge To Repeal ObamaCare

Monday, April 3rd, 2017

obamal

“My legacy continues!”…………..

As the Trump administration continues to debate the future of the Affordable Care Act, a new Obama-era health insurance rule is taking effect…………….

(more…)

The Cost of Convenience

Monday, April 3rd, 2017

ppoo

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

(more…)

Where Art Thou RBR Program Transparency?

Monday, April 3rd, 2017

binocolorsIf an RBR provider’s marketing efforts signal pricing based on a starting point versus an actual post-negotiation result, then the Plan Sponsor will likely be very disappointed

(more…)

Tenet, BCBSTX Sign Multi-Year Agreement

Monday, April 3rd, 2017

dogs

For those of you insured by BCBSTX, would you like to know what kind of prices have been negotiated for you at Tenet Healthcare? Maybe your prices went down?

As a BCBSTX policy holder, whether you know it or not, you have a dog in this pricing arrangement. Why don’t you ask to see a copy of the negotiated contract? After all you will be subsidizing the agreement as a premium paying card carrying member of the Caring Company, right?  

(more…)

Hospital PPO Pricing Exposed in South Texas

Sunday, April 2nd, 2017

topsecretLarge employers of the Lower Rio Grande Valley have relied on third party intermediaries to negotiate pricing with local hospitals for over 35 years. Now, for the first time, some Valley school districts are learning the truth about the value of PPO discounts and they don’t like what they see…….

(more…)

Meet The 105 Year Old Doctor Who Is Still Hard At Work

Saturday, April 1st, 2017

doctor

He worked with Alexander Fleming and was a Prisoner of War 

(more…)