Archive for October, 2017

Working The Spread

Monday, October 23rd, 2017

The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.

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Getting Screwed

Monday, October 23rd, 2017

When it comes to hospital bills, you don’t get the itemized version of the bill, so you often have no idea what you are actually paying for………. (more…)

EDMUNDO O. RAMIREZ  – 1952-2017

Saturday, October 21st, 2017

Edmundo was a fighter. He fought hard for his clients and protected those he loved. He lived life on his own terms, and he died on his own terms. This rock solid, self-made man will be missed by many. 

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Slapped In Texas

Friday, October 20th, 2017

TPA Loses Lawsuit Against Private Citizen

“The Texas Legislature unanimously adopted one of the strongest Anti-SLAPP statutes in the nation and showed their continued support of the First Amendment.  On June 17, 2011, the Texas Citizens Participation Act (the “Texas Anti-SLAPP statute”) was signed into law by Gov. Rick Perry.”

“The statue allows a judge to dismiss frivolous lawsuits filed against one who speaks out about a “matter of public concern” within the first 60 days.  “Matter of public concern” is defined expansively in the statute.” (slappedintexas.com/primer/)

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Pile Makes Incredible Offer

Thursday, October 19th, 2017

“I’ll Make You An Offer You Can’t Refuse”

Can anybody use 5% of their healthcare spend back?? Give me a call so I can show you why there is 5% there and how we will find and recover it for you.

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Direct Pay (Cash Pay) Strategies Make Sense

Thursday, October 19th, 2017

By Bill Rusteberg

Direct Pay strategies, which I call Cash Pay strategies, has had a positive impact on a 400 life case we manage.

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Open Enrollment as Turd Polishing Season is Over

Wednesday, October 18th, 2017

For 20+ years, Open Enrollment has meant explaining to employees how they’re going to pay more and get less when it comes to health benefits……………………..

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TPA Promotes Reference Based Pricing Model – Guarantees No Balance Billing

Wednesday, October 18th, 2017

A TPA specializing in self-funding for small group plans of 100 employee lives or less offers a unique Reference Based Pricing model that includes the promise of no balance billing.

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Opioid Crisis Fueled By Drug Industry and Congress

Monday, October 16th, 2017

Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities — knowing that people were dying — and says industry lobbyists and Congress derailed the DEA’s efforts to stop it

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Insurance Consultants Are Biased

Monday, October 16th, 2017

mulebriar

“The last category of independent insurance consultants are those that are never comfortable outside their insulated environment. They like the warm and fuzzy feeling of staying at home in a loving environment with Mommy.”

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Largest Employer South of San Antonio Seeks Insurance Consultant

Sunday, October 15th, 2017

Brownsville Independent School District, the largest employer south of San Antonio, Texas is seeking an insurance consultant for the district’s self-funded employee health & welfare plan.

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Selecting a Third Party Administrator

Thursday, October 12th, 2017

By William Rusteberg

Selection of a third party administrator (TPA) is crucial to the success of a self-funded plan. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and TPA should harmonize.

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The Cost of Convenience

Thursday, October 12th, 2017

ppoo

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

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Express Scripts to acquire EviCore Healthcare for $3.6

Tuesday, October 10th, 2017

Pharmacy benefit manger Express Scripts will acquire medical benefits management company eviCore Healthcare for $3.6 billion, which will give the company an entry point into a growing market, the company announced Tuesday in a securities filing.

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Dendy Opines

Tuesday, October 10th, 2017

When people or companies live off of opacity, there is a problem as one never knows if they are being treated fairly or not” – Mike Dendy

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How One Of America’s Most Innovative Benefits Leaders Reduces Clients’ Healthcare Spending 20%

Monday, October 9th, 2017

David Conterno

When the industry goes to higher deductibles, we remove them. When the industry goes to narrow networks, we remove networks. When the industry goes to narrow formularies, we expand them. When the industry invests in specialty care and surgical centers, we invest in primary care. When the industry looks to bring in more insurance products, we bring in less. Instead of increasing obstacles to getting any and all care, we need to be removing all obstacles to getting the right care.”

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Risk Tolerance & Reference Based Pricing Strategies

Sunday, October 8th, 2017

By Bill Rusteberg

Plan sponsors must recognize change brings risk and reward and understand doing nothing brings risk too. So what’s the difference?

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Over 1/2 Of New Cancer Drugs Show No Benefit For Survival or Wellbeing

Saturday, October 7th, 2017

Of 48 cancer drugs approved between 2009-2013, 57% of uses showed no benefits and some benefits were ‘clinically meaningless’, says BMJ study…………………

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Is All Preventive Care Screening Cost Effective & Prolong Life?

Saturday, October 7th, 2017

Physician Joins Witness Protection Program?

“We knew for years that if a patient is a smoker the risk of lung cancer is high.   So why did we not have annual chest x-ray as a screening tool? ” (Name Withheld) M.D.

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4 Texas Hospitals Pay $8.6 Million Over Kickback Allegations

Friday, October 6th, 2017

“Why Didn’t I Think of This!

Bernie Madoff

“If not for this kickback arrangement, the four hospitals would have been financially responsible for the patient transports at significantly higher rates………………..”

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How 2 Math Grads are Disrupting the Auto Insurance Industry

Friday, October 6th, 2017

Insurance industry continues to be rocked by innovative upstarts. This time disruption is not confined to health care, it is encroaching upon the property & casualty industry too…………..

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Association Health Plans: A Favorite GOP Approach To Coverage Poised For Comeback

Friday, October 6th, 2017

Under association health plans, small businesses can join associations — based on certain types of professional, trade or interest groups — that offer insurance to members.

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America Is Surprisingly Reliant on Foreign Medical Graduates

Friday, October 6th, 2017

Recent Foreign Medical Graduates Seek Internship in USA

By any objective standard, the United States trains far too few physicians to care for all the patients who need them. We rank toward the bottom of developed nations with respect to medical graduates per population………………….

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Trump Set To Roll Back Birth Control Mandate

Friday, October 6th, 2017

The Trump administration is poised to roll back the federal requirement for employers to include birth control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections……………….

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Moonbeam Ponders Signing Drug Transparency Bill

Friday, October 6th, 2017

“If it gets signed by this governor, it’s going to send shock waves throughout the country…..”

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Employer’s Health Care Congress 2017

Thursday, October 5th, 2017

Jeff Bernhard, President of Continental Benefits

This revolution is happening faster than I would have ever thought.  If you are a consultant and not sharing creative TPA options at this time, you will likely lose to a competitor consultant.”

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Self-Insurance Plan Could Save Idaho $13M, Consultant Says

Thursday, October 5th, 2017

A new analysis on how much Idaho would save by switching public employees to a self-insurance model puts the amount at $13 million for the first year of operation……….

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Health Care Networks of America – Restoring Physician Prosperity!

Tuesday, October 3rd, 2017

“Don’t Miss 70% – 85% of Billed Charge Reimbursement Rates!” touts Health Care Networks of America (HNA).

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Monday, October 2nd, 2017

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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Unique Defined Contribution Plan for Voluntary Benefits

Monday, October 2nd, 2017

What if a plan existed where employees could get what they wanted regardless of their health status and regardless of group participation requirements?

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Employer Healthcare & Benefits Congress

Monday, October 2nd, 2017

The Employer Healthcare & Benefits Congress (EHBC) brings together attendees from across the world to discuss the latest developments in employee benefits industry, from corporate health & well-being programs and the latest in healthcare reform, to trends in voluntary benefits and self funded insurance, the EHBC has the information you need.

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More States Looking to Section 1332 Waivers

Sunday, October 1st, 2017

States can apply for a federal waiver “to implement innovative ways to provide access to quality healthcare……” Does that include Reference Based Pricing strategies?

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The Monty Hall Problem

Sunday, October 1st, 2017

The Monty Hall Problem is an interesting study of Probility & Combinatorics. Actuaries among us will enjoy this short video………………………

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