Removing Waste, Gimmicks, Cost Shifting & Tricks From Healthcare

By Jeff Bernhard, President of Continental Benefits

When I see the below chart, it reminds me how much Employers need real solutions to get the wasted spend out of the system. 

When I see the info in the chart on the right it reminds me of an Employer with an eroding margin.  It also reminds me of the union member that doesn’t get a pay increase because unpredictable healthcare costs have eaten up the budget. 

Lastly, it reminds me of the school that needs to lay off 100 teachers because of the wasted, unnecessary spend in the system. 

It has been this way for the past 20 years and has gotten worse each year. 

I am so glad to bring a real solution, with reputable partners (TBA), in 2018 to the self-funded Employer market that helps self-funded Plan Sponsors get rid of this waste with no gimmicks, cost shifting or tricks.  This solution will work on a “A” carrier PPO network. 

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Protection Money In Healthcare

“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. I am positive we will one day see plan participants sue their plan for breach of fiduciary duties. We are seeing this trend among retirement plans, health plans will be next” – Bill Rusteberg

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This old drug was free. Now it’s $109,500 a Year.

“As long as third party intermediaries continue to pay for these high cost drugs, the manufacturers will remain at the trough…………Many of our clients remove these drugs from their formularies” – Bill Rusteberg

 

 

It takes balls to say ENOUGH IS ENOUGH I’M NOT PAYING THIS ANYMORE!

 

 

 

Self-Funded Plan Sponsor Discovers He Has Balls……….

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Wired For Sound – FBI Builds Insurance Corruption Case

Humana representative Andrew Grove, whom prosecutors named as an unindicted co-conspirator, recorded a May 2013 conversation between himself, Mullen and Hernandez……………..After being confronted by the FBI, Haff agreed to cooperate and began secretly recording conversations ……………….Joshua Cerna was cooperating with the FBI by then, and in a recording of their conversation………………………..

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We Don’t Have To Buy Broccoli Any More?

 

Proposed tax bill, if passed, will eliminate the government’s broccoli mandate. Americans will no longer be forced to purchase broccoli. Currently, citizens who don’t buy broccoli are subject to a  broccoli tax as much as 2.5% of income.

A spokesman for the American Broccoli Association stated “Broccoli is a right, not a food. If broccoli consumption declines, we will see people die in the streets. We are gonna do everything we can to turn this around in 2018!

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San Francisco Increases Health Care Contribution Requirement

 

Ordinance requires employers with at least one employee who works within the city limits to either pay at least a specific amount per hour worked within the city and county limits (or for paid time off) towards the cost of health coverage for any such employee, or pay a surcharge over to the city…………

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“If one has a brain and a backbone, they can achieve amazing things in health benefits. “ – Dave Chase

DELUCA v. BLUE CROSS BLUE SHIELD OF MICH. – Plan Sponsors Beware!

Plan sponsors and their administrators are increasingly at risk of legal exposure for breach of fiduciary duties. This lawsuit is an early example. Experts in our industry suggest more to come, rivaling the potential to earn more in legal fees that will make the famous Tobacco Settlement look like peanuts.

The weapon of choice of plaintiff’s attorneys is:

Section 502(a) (2) of ERISA authorizes a beneficiary to bring an action against a fiduciary who has violated Section 409. Massachusetts Mutual Life Ins. Co. v. Russell, 473 U.S. 134 , 140, 105 S.Ct. 3085, 3089, 87 L.Ed.2d 96 (1985). The Supreme Court explained in Russell that “[a] fair contextual reading of the statute makes it abundantly clear that its draftsmen were primarily concerned with the possible misuse of plan assets, and with remedies that would protect the entire plan, rather than with the rights of an individual beneficiary.”

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