Archive for August, 2017

David Contorno

Thursday, August 31st, 2017

Attention all TPA’s and PBM’s that may want to work with me and my clients……you will give me any and all data I ask for, in an expeditious and COMPLETE manner, without talk of extra costs or complexity. Your entire purpose is to analyze data and make decisions on that data, on behalf of our clients, with their money.

(more…)

National Direct – Satisfying the Greed Factor

Thursday, August 31st, 2017

WHY WORK FOR ANYTHING LESS THAN THE MOST YOU CAN GET?”
(more…)

Why The Healthcare Industry Will Eliminate PPO Networks

Thursday, August 31st, 2017

Mike Dendy

Eliminating the PPO domination of healthcare financing will represent a paradigm shift but one that is long overdue.

(more…)

Anthem Steers Members Away From Hospital Based Imaging Services

Wednesday, August 30th, 2017

In a move that it says will save members money, Anthem is rolling out a program that steers individuals away from hospital-based imaging services and toward less costly, freestanding imaging centers.

(more…)

BCBS of Georgia’s Solution to Non-Emergency ER Visits?

Wednesday, August 30th, 2017

BCBS of Georgia held a webinar last week. From what we have been told, BCBS and Anthem are cancelling Emergency Room benefit payments that are not “emergencies.” We have done the same with some of our self-funded clients. Significant savings have been achieved. No longer will Mommy take little Johnny to the ER for a fever and pay a low co-pay. Now when Little Johnny’s mommy gets the bill, her co-pay for non-emergency ER visits will be 100%……………….

(more…)

To Promote Health Care Excellence, Let’s Recognize Approaches That Assure Value

Tuesday, August 29th, 2017

Aug 28, 2017

BY BRIAN KLEPPER

A challenge for health care purchasers is choosing vendors whose performance matches their cost and outcomes claims. A 2015 Mercer surveyfound that only 41 percent of worksite clinic sponsors think that they’re saving money. As Al Lewis and Tom Emerick have detailed, many wellness and disease management companies simply overstate their results. In many cases employers may not realize that they, not the vendor, take the risk for results.

(more…)

Report Touts PBM “Savings” off Egregious Sticker Prices?

Tuesday, August 29th, 2017

Part-time PBM Salesman

“Costs would run an estimated 58 percent higher without PBM management tools and the pharmacy pricing and manufacturer discounts negotiated by the PBM”.

(more…)

Aetna Violates HIV Patient’s PHI? 12,000 HIV Patients Affected?

Tuesday, August 29th, 2017

Legal groups on Monday filed a class-action lawsuit against the health insurer Aetna, alleging the company violated the privacy of its customers by sending many of them letters through which the phrase “filling prescriptions for HIV” was visible through envelope windows.

(more…)

WellNet’s Fall Broker Tour Offers Self-Funded Insights with Focus on Reference Based Pricing

Sunday, August 27th, 2017

WellNet’s Fall Broker Revolution Tour is coming to a city near you. This tour is for brokers and consultants whose clients are tired of the carrier lip service.

(more…)

General Patton Addresses His Troops

Friday, August 25th, 2017

Damn it! We can’t continue to go around selling PPO plans instead of reference based pricing plans…..

(more…)

Converting PPO “Discounts” To Medicare Allowable

Tuesday, August 22nd, 2017

They were floored and shocked to find out that the 60% discount of billed charges in their area actually converted to 270% of Medicare charges!……………

(more…)

Money Affects Behavior

Tuesday, August 22nd, 2017

Amazing what people will do when they get told what their real costs are…………….

(more…)

PBM’s Bypass Middlemen – Cutting Out Insurance Companies From Gravy Train

Friday, August 18th, 2017

By cutting certain players, often insurers, out of the drug supply chain, disruptors are challenging the drug-pricing paradigm, as well as the value of prescription coverage…………

(more…)

Express Scripts Lawsuit Should Raise Everyone’s Eyebrows 

Friday, August 18th, 2017

The information that’s revealed is shocking………………….

(more…)

Texas Balance Billing Law To Take Effect September 1

Thursday, August 17th, 2017

The bill expands a patient’s ability to mediate their claims with the insurance companies and sets new guidelines for mediation………………….

(more…)

Bernhard Opines on Fake News – PPO Discount Game

Thursday, August 17th, 2017

Jeff Bernhard – President of Continental Benefits

Does everyone realize that a discount guarantee is really useless/ineffective for a self-funded offer/RFP? When does a discount ever lead to lower spend? How silly!

(more…)

Medicaid Overpaid Texas $18.9 Million For School Based Health Services

Thursday, August 17th, 2017

Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back.

(more…)

Blue Cross Michigan Hit With Flurry of ERISA Lawsuits

Thursday, August 17th, 2017

A Shell Game Common To Health Care Financial Transactions

As a plan sponsor are you paying undisclosed fees that don’t show up on the fixed cost side of the ledger but rather on the claim cost side? There are numerous lawsuits that have exposed this industry practice and is not limited to BCBS………………….

(more…)

Texas Permanently Bans Taxpayer Funding of Abortion

Wednesday, August 16th, 2017

Bill prohibits insurance providers from forcing Texas policy holders to subsidize elective abortions

(more…)

Freedom Plan

Tuesday, August 15th, 2017

A Man Before His Times – Martin Luther announcing “Free at Last” Reference Based Pricing Plan

(more…)

Nixon Went to China. Can Trump Go to Single Payer?

Tuesday, August 8th, 2017

Only Trump can make single-payer health care happen in this country…………..

(more…)

Why A Pennsylvania Insurer’s Collapse Could Whack Californians In the Wallet

Monday, August 7th, 2017

Penn Treaty’s liquidation poses a “potential shock to the health marketplace” as the losses pile up, according to the A.M. Best credit rating firm. Industry analysts estimate the parent company has long-term claims liabilities approaching $4 billion, but only about $700 million in assets.

(more…)

Your Network Discount Analyses Are Useless

Saturday, August 5th, 2017

Throw it in the trash. Seriously…………………. 

(more…)

Smoke & Mirrors – Comparing PPO “Discounts”

Saturday, August 5th, 2017

Many independent fee based insurance consultants are sucked into the PPO “discount” vortex……………..

The carriers are very good at playing this game and my belief is that most consultants don’t get it or pretend not to get it, thus doing a great dis-service to their client.”   – PHO Sales Representative

(more…)

Cigna, Other Health Insurers’ Profits Surge, Ignoring ACA Chaos

Friday, August 4th, 2017

U.S. health plans stocks up 26%, outperforming S&P 500…………….

(more…)

Institute For Supply Management Announces September Seminar

Wednesday, August 2nd, 2017

 

This program is applicable to all areas of the public education sector, including school districts, junior colleges, and colleges.

(more…)

What Employers Need To Know To Manage Health Costs

Tuesday, August 1st, 2017

Employers can immediately reduce the cost of health insurance by 20% by simply shifting their focus to proven strategies…..

(more…)

Why Most Health Plans Strive To Make Healthcare Cost More

Tuesday, August 1st, 2017

 Brian Klepper

“The truth is that group health plans typically earn a percentage of total expenditures, and it is in their interest for healthcare to cost as much as possible.”

(more…)