Archive for November, 2017

Does BCBS Manage Claims or Do They Just Pay Them?

Sunday, November 19th, 2017

One of my arguments about Blue Cross is that they do not manage claims, they just pay them…..

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PPO “Discounts” Off Billed Charges Mean Nothing

Sunday, November 19th, 2017

 

A fascinating study by Alan T. Sorensen in 2003 on PPO discount patterns is an instructive read. The State of Connecticut’s data of the state’s hospital industry provided Sorensen a rare opportunity to study payer-level differences in negotiated discounts for hospital services and gives the reader insight into certain myths the managed care industry (including carriers, TPAs, agents and brokers) have successfully foisted upon clueless consumers for the past 35 years.

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83% Of Business Leaders Think Their Insurance Agents Suck!

Sunday, November 19th, 2017

Benefits represent a company’s second largest expenditure, yet only 17 percent of business leaders think their programs are being managed effectively…………..

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How One Insurer Makes A Fortune By Reducing Healthcare Costs

Saturday, November 18th, 2017

“The best way to lower health care costs is to lower health care costs”……………”Healthcare costs are directly related to what we agree to pay for healthcare”…………………..”The secret to lowering health care costs is to find providers willing to take less and discarding providers who want more – it’s called Free Market”…………. “If you want to cut your health care costs by 50% and more, without sacrificing quality or level of benefits, you can…………………”

The following article proves all of the above:

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Request For Proposals – Non-Disclosure Statement

Friday, November 17th, 2017

By Bill Rusteberg

Acting as a fee based insurance consultant in managing a formal, public Request For Proposal process requires adherence to certain guidelines memorialized in statutes pertaining to political subdivisions.

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HOLY BENEFIT MANAGEMENT, BATMAN!

Wednesday, November 15th, 2017
 
Employers are unhappy with their PBM relationships. Only one-third of employers rated their PBM as “very trustworthy.”

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TRS Care Marketing Opportunity for Insurance Agents

Tuesday, November 14th, 2017

As expected, there are many people leaving TRS and trying to secure a new health and drug plan in 2018……

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DOL Gives Kiss of Death in “Healthcare Madoff” Scheme

Monday, November 13th, 2017

By Mark Flores

The Complaint also alleges multiple violations of ERISA including, using plan assets to pay excessive fees and expenses, assessing undisclosed fees to the contribution amounts, failing or refusing to pay approximately $16 million for member’s medical claims, then transferring unpaid monies to offshore bank accounts in Bermuda.

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Veterans Day 2017

Friday, November 10th, 2017

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

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How Reinsurers Help Hedge Funds Shelter Taxes

Friday, November 10th, 2017

Zero tax rate attracts money offshore………………………..

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The Smart Plan

Friday, November 10th, 2017

QUESTION: What’s the opposite of “Smart?”

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Humana Profits Fall As Insurer Cuts 2,700 (Human) Jobs

Thursday, November 9th, 2017

Humana said the company is cutting the jobs in part to invest in technology………….…………

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County Continues To See Drug Savings Through Canadian Rx Mail Order

Wednesday, November 8th, 2017

The county continued to save money this year under its Canadian prescription drug program, county officials said Friday……

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‘High-Performance’ Health Innovators Could Improve Outcomes, Lower Costs

Tuesday, November 7th, 2017

Consider what might happen if you could, say, guarantee a benefits manager a 25% reduction over current healthcare spend, with better outcomes. That would be an offer that she couldn’t refuse, especially if her CFO heard about it.

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Confessions of a Reformed Health Insurance Broker – From Innocence To Darkness

Sunday, November 5th, 2017

Slowly we saw the rise of third party administrators, the evil purveyors of self-funded employee health & welfare plans…..

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WHY AN ‘OUTRAGEOUS’ $169,600 MEDICAL BILL ACTUALLY GOT PAID

Sunday, November 5th, 2017

OUTRAGED CONSUMER

Would you pay $169,600 for a $3,000 – $4,000 procedure? Well, guess what, you have already – it’s embedded in your health insurance premiums…………………..

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Cost Plus Rx Model For Self-Funded Health Plans

Friday, November 3rd, 2017

We bring you a network of independent pharmacies with a simple and unique pharmacy payment model. Our cost plus model reimburses drug costs via the nationally published public NADAC list and a fixed drug dispensing fee. No more arcane acronyms like MAC, AWP, and WAC and no more lengthy contracts detailing complex generic and brand definitions.

Editor’s Note: If you are in the pharmacy business I would like to hear from you – any comments or suggestions you may have I will post in a follow-up blog posting………….Rx costs are out of control and the PBM world doesn’t seem to care. Perhaps PBM’s are the bad guys? If not, convince me please………………Write to RiskManager@RiskManagers.us

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Blue Cross Blue Shield of Arizona PPO Rental Network

Thursday, November 2nd, 2017

Blue Cross Blue Shield of Arizona (BCBSAZ) provides large, self insured groups access to the BCBSAZ provider network……………..But how do they keep their PPO payment methodologies secret from the TPAs and more importantly, plan sponsors who pay the bills?

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The Deception Behind Those In-Network Health ‘Discounts’

Wednesday, November 1st, 2017

UnitedHealthcare  boasts that its PPO—a network of more than 780,000 professionals—cuts the cost of typical doctor visits by 52%, while saving 69% on MRIs. Pull back the curtain, and you’ll see these discounts are an accounting trick. To allow PPOs to advertise big discounts, providers simply inflate their billed charges on a whole range of services and treatments.

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