Archive for June, 2017

Attention: Hospitals & Their Attorneys Are Prohibited From Reading This Blog

Tuesday, June 27th, 2017

In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.

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Warren Buffett: Singer Payer is “The Best System For America”

Tuesday, June 27th, 2017

“We can afford to do it” – Warren Buffett

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Broker Compensation by Health Insurance Market

Tuesday, June 27th, 2017

Sources: Kaiser Family Foundation analysis of data from Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the National Association of Insurance Commissioners and California’s Department of Managed Health Care. Mini-med companies with a medical focus were included.

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UnitedHealthcare Explains Producer Compensation

Tuesday, June 27th, 2017

Compensation paid to producers under these agreements is usually based on growth and persistency of a producer’s overall book of business. The costs of these programs are not directly included in the premiums or fees for the producer’s customers, but are included in our general distribution costs.

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Harvard Risk Management Corporation Thrives In Niche Market

Monday, June 26th, 2017

Last year our agents earned over 114 million dollars in commissions and we plan to double that in 2017!  (more…)

San Antonio Company Provides Stop Loss Insurance

Monday, June 26th, 2017

SA Benefit Services, LLC principals have more than 30 years of combined stop loss experience. We provide stop loss services to third party administrators, consultants, brokers and direct with self-funded groups who have no broker of record. We use only A Rated stop loss carriers.

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Texas Hospitals Fear Losing $6.2B Medicaid Deal

Monday, June 26th, 2017

Medicaid in Texas is a $29,000,000,000 ($29 BILLION) business………………...

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54 Healthcare Blogs To Read

Sunday, June 25th, 2017

Staying on top of new developments occurring at breakneck speed poses a challenge for healthcare professionals……………

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What Is A QSEHRA ?

Saturday, June 24th, 2017

Hint: A QSEHRA is something conjured up at the Puzzle Palace in Washington DC…..

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AMPS Ranked Among Top Fastest Growing Middle Market Company in Georgia

Saturday, June 24th, 2017

The Atlanta Chapter of the Association for Corporate Growth has identified AMPS among the top 40 fastest growing middle market companies in Georgia………….

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Cimarron Healthcare Capital Announces Recapitalization of AMPS

Saturday, June 24th, 2017

“Last year AMPS grew by over 70% and we are on a financial track to do the same this year, and we see this strategic investment extending the significant growth we have enjoyed over the past five years.” – Mike Dendy

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Georgia Hospital Sues Blue Cross

Saturday, June 24th, 2017

The hospital claims BCBS of Georgia is refusing to pay contractually agreed-upon rates.

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Single Payer Healthcare Dies On Left Coast – Liberals Outraged

Saturday, June 24th, 2017

“Acting in secret in the interests of the profiteering insurance companies late Friday afternoon abandons all those people already threatened by Congress and the Trump administration” – Deborah Burger

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Insurance Agent E&O Coverage in Minutes

Friday, June 23rd, 2017

Get Insured 24/7 has the lowest rates for Errors and Omissions Insurance, providing affordable, easy access to protection for the unexpected. Use our secure portal to enroll and bind in minutes, wherever you are, whenever you want. Pajamas welcome.

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Rand Paul: Insurance Should Be Available For $1 a Day

Friday, June 23rd, 2017

“What I’d like to do is legalize inexpensive insurance, and you should be able to get insurance for $1 a day” – Rand Paul

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Questcor Finds Profits, at $28,000 a Vial

Friday, June 23rd, 2017

The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial…………….

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Green Imaging

Friday, June 23rd, 2017

MRI’s can start as low as $250…………Compare that to $2,000, $3,000, $4,000 and more elsewhere………..

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Vxtra Partners

Friday, June 23rd, 2017

Vxtra Partners was founded in 2004 to address the financial inequities, lack of transparency, and technology challenges associated with traditional health care benefits.

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Hospital Stocks Rally

Friday, June 23rd, 2017

Hospital stock prices jumped on Thursday as investors reacted to the Senate’s proposal for repealing and replacing the Affordable Care Act.

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Senate Republicans Post ACA Change Bill Draft

Thursday, June 22nd, 2017

Congressional Aide Drafts Healthcare Bill 

The bill will “ultimately transition away from Obamacare’s collapsing system entirely so more Americans won’t be hurt,” McConnell said Thursday on the Senate floor.

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Simplifying Payments…………….Simplifying Healthcare

Thursday, June 22nd, 2017

Accresa is an innovative payment platform that connects physicians, employers and employees…………..

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Reference Based BULL-ING………..A Primer For Hospitals

Thursday, June 22nd, 2017

“As any person being bullied knows, and as Freud has written, there are two options: 1. Fight or 2. Flight” – Shawn Gretz

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Job Opening – Health Insurance Consultant

Thursday, June 22nd, 2017

“This could be a career opportunity of a lifetime. We are building something unique……….”

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McAllen ISD Seeks Competitive Proposals for Self-Funded Health Plan

Wednesday, June 21st, 2017
Incumbent Group Rep. Expresses Angst
Tis the season for competitive RFP’s in the Lower Rio Grande Valley, Texas. Here is the latest………..

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Your Insurance Committee is Stupid

Wednesday, June 21st, 2017

“Your insurance committee is way out in left field! Why would anyone want lower benefits at a higher price!” offered the consultant.

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The Alabama Physicians and Dentists Direct Pay Act.

Tuesday, June 20th, 2017

Dr. Chad Williamson last year opened his direct-pay clinic. He has 300 patients who pay $60 per month per individual or $100 per couple. Children are $10 a month. He doesn’t accept insurance, though he said about half his patients do have it…………..

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Selerix

Tuesday, June 20th, 2017

Selerix Systems produces software (BenSelect) to facilitate communication, enrollment, and end-to-end benefits administration for both core and voluntary insurance products. This software is licensed to and used by carriers, brokers, and employers.

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Health Care 50 Years Later

Monday, June 19th, 2017

In 1967, our population was 204 million and our national health expenditures were 46.5 billion, 5.7% of our GDP or $253 per person. Today, for our population of 330 million, they’re $3.2 trillion, 17.8% of our GDP and $9990 per person…….

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TRS Announces Rate Increase For TRS ActiveCare Program

Monday, June 19th, 2017

“It is a program without any sense of risk management, so this will continue to be the pattern until they kill it.  One of the biggest issues is the consulting firm, which has worked with them forever and is not even located in the State.” – Insurance Consultant

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Nevada Governor Vetoes Medicaid-For-All Bill

Monday, June 19th, 2017

Gov. Brian Sandoval vetoed a bill that would have would have made Nevada the first state to attempt a Medicaid-for-all approach to health insurance

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TAGCO Provides Retiree Healthcare Solutions for Employers

Saturday, June 17th, 2017

The TAGCO Multiple Employer Trust offers employers the benefits and advantages of buying Retiree Medical through the pooling of statewide Retiree Medical risk(s). The program serves residents of Arkansas, California, Louisiana, Montana, Oklahoma, South Carolina, Texas, Virginia, Colorado, Illinois, Iowa, Michigan, Nebraska, North Carolina, New Mexico, Tennessee, Utah, and Wyoming.

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Why Employers Need To Offer Retiree Healthcare Benefits

Saturday, June 17th, 2017

Take a total benefits approach. This approach could help minimize liabilities while maximizing total benefits spend. Additionally, savings in one benefits area could allow additional funding for new retiree healthcare solutions……………….Coupling retirement healthcare with Reference Based Pricing strategies may accomplish this goal…………..

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Nevada Forces Drugmakers to Reveal Insulin Pricing, Profits

Friday, June 16th, 2017

The law requires drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin…………….

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Controlling Medical Costs In Self-Funded Employer Benefit Plans

Wednesday, June 14th, 2017

This paper will address the cost drivers and why the traditional solutions are becoming more and more ineffective…………….

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PPO Networks: The Devil Employers Think They Know

Wednesday, June 14th, 2017

Is the fox is watching the henhouse? The abuses that can and do exist under this model are egregious…….

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4 Mistakes Businesses Make When Managing Health Care Expenses

Wednesday, June 14th, 2017

 Mike Dendy

I recently met with a Fortune 100 company and posed the question, “how much are you paying for hospital services within your PPO network”? They had absolutely no idea. I was not at all surprised, as the actual cost of services is well hidden within a labyrinth constructed by big healthcare companies, their PPO organizations, and their “partner” hospitals.

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The Evolution of Reference Based Pricing Plans

Tuesday, June 13th, 2017

The number of employers implementing RBR plans is increasing, especially in markets where providers have shown a willingness to accept “reasonable” reimbursement……………..

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Lucent Health Solutions Inc., Acquires Cypress Benefit Administrators

Tuesday, June 13th, 2017

Nashville, Tennessee, June 7, 2017- Lucent Health (@LucentHealth), the leading Healthcare Risk Management, Administration and Advisory Services company, announced today that it has acquired Appleton, Wisconsin-based  Cypress Benefit Administrators.

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Crack Healthcare Costs with Cash

Tuesday, June 13th, 2017

Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…

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How To Evaluate A PBM Offer

Tuesday, June 13th, 2017

Mildred Honeycomb, Famed PBM Professor at MMU

A two sentence tutorial on how to evaluate a PBM proposal…………………..

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Switch Operators Scheme to Undermine Plan’s Cost Savings Efforts

Tuesday, June 13th, 2017

Switch operators are like the Wizard of Oz: They’re hidden behind a curtain and being paid by manufacturers to end-run your cost-savings efforts. Therefore, you need to pull back the curtain, understand their machinations, and respond.

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Mulebriar Vents, Threatens Tahiti Move

Tuesday, June 13th, 2017

A large taxpayer supported employer now knows they are overpaying for health care……

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How An Industry Shifted From Protecting Patients To Seeking Profit

Sunday, June 11th, 2017

In 1993, before the Blues went for-profit, insurers spent 95 cents out of every dollar of premiums on medical care, which is called their “medical loss ratio.”

The average medical loss ratio is now closer to 80 percent. Some of the Blues were spending far less than that a decade into the new century.

The medical loss ratio at the Texas Blues, where the whole concept of health insurance started, was just 64.4 percent in 2010.

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Employers May Become Their Own PBM

Saturday, June 10th, 2017

Another form of direct contracting is when a plan sponsor outsources the administrative systems and support functions required to operate as a PBM, to a third-party vendor. These vendors can operate “behind the scene” and enable the plan sponsor to “private label” the PBM services.

The benefits to the plan sponsor includes marketplace branding, local control of utilization, formulary design control, acquisition-based drug costs and full share of rebates and manufacturers’ incentives. As a result of these comprehensive support services, plan sponsor’s of almost any size can potentially benefit from these new arrangements and may represent a significant improvement over traditional service contracts.

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Why GE, Boeing, Lowe’s, and Walmart Are Directly Buying Health Care for Employees

Friday, June 9th, 2017

“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

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Rosenthal’s Ten Commandments

Friday, June 9th, 2017

“In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.”

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Sprinklecare & Spitballs

Friday, June 9th, 2017

“So we spit-balled some ideas around and came up with this: The one package people are highly pleased with is Medicaid………………”

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Listserv Group Discusses Santa Claus & Single Payer System

Thursday, June 8th, 2017

Politicians act the way they do because Santa Claus is here and here to stay………..

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“ERISA Fiduciary Largest Undisclosed Risk I’ve Seen in My Career”

Thursday, June 8th, 2017

  David Chase

Emerging Litigation Could be the Savior to Our Dysfunctional Healthcare System. Here’s how………………..

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Former Pharma Reps School Docs on High Drug Costs

Thursday, June 8th, 2017

As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year. Then he joined the Traitors Club of former pharma reps……….

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Telemedicine For Marijuana Lovers

Thursday, June 8th, 2017

HelloMD is a service that uses telemedicine to connect people with doctors willing and able to prescribe medical marijuana…………………

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Loaded Dice – PBM’s Are Winning The Cash & Rebate Game

Wednesday, June 7th, 2017

“Taken from a scene in the holiday classic, A Christmas Story, I double dog dare you now to ignore the new information I’m about to share with you” – Tyrone Squires

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Sun Life Reports +$1 Million Claimants Up 26%

Wednesday, June 7th, 2017

“The total of all Sun Life Stop-Loss claims reimbursements from 2013 to 2016 was $2.7 billion. If those stop-loss claims reimbursements are added to first-dollar catastrophic claims costs (the amount that employers pay before reaching the stop-loss deductible), the overall cost for catastrophic conditions was $6.1 billion…. Million-dollar+ claimants were up 26% compared to 2012-2015. In 2016, this group represented only 2.2% of claimants but accounted for 23% of all stop-loss claims reimbursements.”

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This Man Will Help You Get Out of Expensive Medical Bills

Wednesday, June 7th, 2017

I’m angry that people who don’t understand and can’t help themselves and don’t know how to fight back are getting ripped off every day.” – David Silverstein

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How To Reduce Health Care Costs & Improve Benefits At The Same Time

Wednesday, June 7th, 2017

davechasebook

We learned back in 2007 that we can reduce health care costs for our clients by 40-50% while improving benefits at the same time. Few listened then, afraid to break away from the status quo. Now we find articles like the following one by Dave Chase. This, and his upcoming book, is a Must Read for employer sponsored health plans – Bill Rusteberg

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Fiduciary Duties – You Mean that Stuff Applies to the Health Plan I Sponsor, Too?

Tuesday, June 6th, 2017

poyner

In the summer of 2016, over 100 of CIGNA’s self-insured health plan clients were sued with the complaint alleging breach of the defendants’ fiduciary duties under ERISA for engaging in widespread fraudulent behavior involving the use of plan funds. This case should serve as a wake-up call for employers sponsoring health plans nationwide – this will not be the last case of its kind to be filed.

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“Tax The Rich!” Liberals To Drive Aetna From State After 164 Years?

Sunday, June 4th, 2017

thatcherq

The Aetna insurance company has been based in Hartford, Conn., since 1853, but this week it said it is looking to move to another state…………

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San Benito ISD Believes Practice Makes Perfect

Sunday, June 4th, 2017

practiceNeed practice in responding to a Request for Proposal for Group Health Insurance? If so the San Benito Independent School District is here to help you……………..

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Express Scripts Lawsuit Reveals Dark Secrets

Saturday, June 3rd, 2017

cookie

No one has been able to determine how much a  PBM is profiting from its secret “deals” with manufacturers………..Express Scripts lawsuit raises eyebrows…………..

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BCBS Aggressively Tackles Non-Emergency ER Visits

Saturday, June 3rd, 2017

emergency

Blue Cross and Blue Shield of Georgia  has just informed its members that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their claim won’t be paid…………

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Texas Bill To Address Unconscionable ER Prices Fails To Pass

Saturday, June 3rd, 2017

shocked

TEXAS HOUSE BILL 3867 – AN ACT relating to unconscionable prices charged by certain health care facilities for medical care.

For purposes of Section 17.46(a), the term “false, misleading, or deceptive acts or practices” includes an emergency facility taking advantage of an individual’s medical condition by:

(1)  providing emergency care at an unconscionable price; or

(2)  demanding or charging an unconscionable price for or in connection with emergency care or other care at the facility.

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Half Of All U.S. Retail Jobs Could Vanish

Friday, June 2nd, 2017

checkout

“For the record, C-suite executives are actively engaged in reducing health care costs in the US, not by what they consider penny ante changes in plan design, but by replacing workers with robots and automation, self checkout machines, push button ordering in restaurants and drive thru food serves, etc etc etc. That not only cuts benefit costs but wages, workers comp, payroll taxes, sick leave, life insurance, training, on and on.  This is not to mention the rush to send US jobs to India and Mexico.  That’s how the c-suite is engaged.” – Tom Emerick  (www.emerickconsulting.com)

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Working The Spread

Thursday, June 1st, 2017

spread

Without disclosure to Plan Sponsor or the providers – the TPA simply misappropriated the difference between what Plaintiffs paid the TPA and what the TPA negotiated to pay the providers. Working the spread is a lucrative business………………..

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Your Fired!

Thursday, June 1st, 2017

fired

How the Molina Brothers Got Bounced From the Family Health-Care Firm…..

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$12,000,000 Man

Thursday, June 1st, 2017

yikes

“Everyone is trying to avoid the $12 million-man,. Because whoever catches him basically can’t make money.”

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The Leaks Keep Coming………..

Thursday, June 1st, 2017

leaks

“I want you to know that your long ordeal will soon be over,” Trump promised………….

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