Archive for June, 2018

The Untouchables

Friday, June 29th, 2018

Standard HR demands include:

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Medical Trend For 2019

Friday, June 29th, 2018

Medical cost trend – Behind the numbers 2019

Employer medical cost trend has plateaued. PwC’s Health Research Institute projects employer medical cost trend will be 6 percent for 2019, the same as 2018. Cost reduction efforts will shift to prices.

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David Belk

Friday, June 29th, 2018

Hello Everyone!

I know it’s been a while since I’ve sent out an update, but I’m still busy writing my book (which is taking a lot of my time). I’m nearly done and currently trying to find a publisher (which is also quite difficult). In the meantime, I have updated one of the pages in my website, so I thought I’d share my recent findings with all of you since I think most people will be surprised with what I’ve found.

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Transparency In Retirement Plans – Why Not Health Insurance Plans?

Thursday, June 28th, 2018

Employer thought they were paying their broker $126,000 per year. They were actually paying more than that………………………

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Status Quo Under Attack

Thursday, June 28th, 2018

Traditional health insurers, hospitals and independent physicians who refuse to change will become obsolete…………………………….

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Spreadsheet Fiasco Leads To Firing

Wednesday, June 27th, 2018

AUSTIN — The state has canceled five new managed-care contracts for low-income youngsters enrolled in the Children’s Health Insurance Program after finding errors in a spreadsheet used to evaluate bids.

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Texas County Believes in Magic

Wednesday, June 27th, 2018

A Texas county believes in magic. Facing ever increasing health care costs the county resorts to status quo strategies to temper increases – it’s called cost shifting……………………Meanwhile back at the ranch some Texas political subdivisions are improving benefits and lowering costs at the same time…………………………Health Care Strategies for Political Subdivisions

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Oklahoma Welcomes Medica

Wednesday, June 27th, 2018

Major Health Insurer Medica Brings New Competition to Individual and Family Health Insurance Market in Oklahoma…………………….

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Insurance Giant Acquires Wortham

Tuesday, June 26th, 2018

Wortham Insurance has agreed to a buyout by Marsh, a wholly owned subsidiary of New York-based Marsh & McLennan Companies Inc., combining two well-known names……………..

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Health Insurers Love The “Affordable Care Act”

Tuesday, June 26th, 2018

Health insurers are finding success in ObamaCare this year and are planning to expand their offerings in many states……………………..

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Is It Legal?

Monday, June 25th, 2018

Does anyone know for sure if the Texas Department of Insurance has any jurisdiction over Reference Based Pricing vendors who for a fee indemnify plan members against the risk of lawsuits and balance billing? Is the act of indemnification for a fee through transfer of risk the business of insurance?

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What Causes Hyperinflation in Medical Costs? It’s Health Insurance Stupid!

Monday, June 25th, 2018

Medical insurance directly causes price hyperinflation, because it insulates the patient from the financial impact of their medical care decisions…………………

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The Latest In Texas v. United States

Monday, June 25th, 2018

 

Following the Trump administration’s surprise move not to defend major components of the Affordable Care Act (ACA), much more attention is being paid to litigation over the individual mandate known as Texas v. United States.

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Amazon, Berkshire Hathaway, JP Morgan Target Point of Service Claim Adjudication

Monday, June 25th, 2018

POSCA is coming and it’s gonna be really cool……………………….

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Why Work For A Living When Stealing Is Easier?

Monday, June 25th, 2018

The city of Miami, Miami-Dade County public schools and several companies lost millions of dollars in health insurance payments as a result of being scammed by crooked clinics that submitted bogus claims for pain injections, according to newly filed indictments……………….

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The Impact of Catastrophic Claims  (Plan on Continuing Rate Increases)

Friday, June 22nd, 2018

 The Affordable Care Act did anything but make health care and health insurance more affordable.  The law that was supposed to drive costs down actually did the exact opposite……………………….

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BREAKING: Xerox Can’t Blame Doctors In $1B Texas Medicaid Fraud Row

Friday, June 22nd, 2018

Texas filed suit in May 2014 alleging the Xerox unit then known as ACS State Healthcare LLC, which administered claims for Texas from 2004 until 2012, signed off on $1.1 billion in claims for orthodontic services, a “substantial percentage” of which were allegedly paid in violation of Medicaid policies….…………….

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Government-Enabled Kickbacks Escalate Medical Prices

Friday, June 22nd, 2018

 

“Since the federal healthcare Anti-Kickback Statute GPO exception was created 30 years ago, the landscape has changed. The current GPO funding structure’s incentive is to ‘negotiate’ higher prices for its customers. The vendors with the most money can afford to pay the high fees and buy themselves into the game. The term ‘payola’—pay to play—comes to mind. The situation is exacerbated because insurers absorb the higher prices and thus hospitals may have less incentive to monitor pricing.”

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Must Reference Based Pricing Vendors Be Licensed?

Thursday, June 21st, 2018

Hospitals and their attorneys are getting creative. One issue of particular interest outlined in the article is apparently a new line of attack……………………..

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We’re not good golfers…………………

Thursday, June 21st, 2018

This is one of the best insurance agency websites I have seen in a long time. They memorialize their philosophy in a compelling manner………………………….

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Embodiment of Corruption: Your Health Insurance Network

Thursday, June 21st, 2018

Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..

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Government Control of Health Care Loosened in Bold Move

Thursday, June 21st, 2018

Move keeps the government officials from using its power and influence to direct the practice of medicine……………………….

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Why Do Prescription Prices Vary By Up to 1,300%

Thursday, June 21st, 2018

Learn how a recent study found that prices for 5 commonly prescribed prescription drugs varied but up to 1,300% based on where the drugs were purchased.

Montana Experiences “Holy Cow” Moment

Thursday, June 21st, 2018

Montana’s high-stakes game of chicken designed to change how the state did business with its 60 hospitals, which accounted for 43 percent of employee health care costs, turning the normal purchasing process on its head……………………..

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Sana

Thursday, June 21st, 2018

Are you looking for new commission and bonus opportunities: Join us for a catered lunch at one of our local Texas events to learn how Sana is changing health insurance. Plus meet the founders.

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Reference-Based Pricing Litigation: Brick By Brick

Thursday, June 21st, 2018

By Scott Bennett – www.linkedin.com/in/scott-bennett-72014594/

Whether you believe modern Reference-Based Pricing models are presently being built, remodeled, or dismantled “brick by brick” truly depends on your perspective. Either way, this is an interesting time to review the recent challenges, results, and future risk created by this important approach to health care reimbursement, which has saved employers millions of dollars and sparked fierce conversations about reasonable value across the nation.

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Renting Medicare’s Provider Network

Wednesday, June 20th, 2018

 democratrepublican

An idea with bi-partisan support?

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Association Health Plans Go Into Effect

Wednesday, June 20th, 2018

This expansion of health care choices returns certain risk manager tools stolen by the government with the passage of the Affordable Care Act (ACA):

☐ Allows plans to exclude coverage for maternity care, prescription drugs, mental-health services and other ‘essential health benefits’ the ACA requires of coverage

☐ Plans will have more freedom to charge different prices depending on customers’ ages, genders and locations — something ACA coverage cannot do.

☐ The regulations erase a requirement that any association must already have existed for a purpose unrelated to health insurance.

☐ These plans will also be able to reduce administrative costs and strengthen negotiating power with providers from larger risk pools and greater economies of scale….

☐ Moves health-insurance regulation from the state level to the federal level.

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Peeling Back The Health Care Onion

Tuesday, June 19th, 2018

“Colorado hospitals statewide are paid an average of 290% of Medicare for inpatient services and 520% of Medicare for outpatient services…………………”

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Unwieldy Health Costs Often Stand Between Teachers And Fatter Paychecks

Tuesday, June 19th, 2018

In an era of $100,000-a-year drugs and government budget cuts, school districts are struggling to find the money to keep up their end of the bargain (providing benefits), forced to take away from classroom funding and even modest, cost-of-living raises. Many cash-strapped school boards, cities and legislatures view health care benefits as an unpredictable budget-buster.

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Don’t Hire An Actuary Because You May Get Really Bad News

Tuesday, June 19th, 2018

As a benefits consultant, if you not employing a licensed actuary providing these services your competition will……………………………..

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McAllen Independent School District Seeks Reference Based Pricing Vendor

Monday, June 18th, 2018
The McAllen Independent School District in deep South Texas is seeking competitive proposals for Reference Based Pricing plan administrator. Sources say the district is facing increasing health care costs and seeks to adopt a Reference Based Pricing plan option to offer in addition to their current PPO plan.

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Why You Will Never Win

Monday, June 18th, 2018

This was sent to several of us this afternoon from the one and only, Carl Schuessler, health care disruptor extraordinaire.

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Introductions Are Worth Big Bucks In The Insurance Industry

Thursday, June 14th, 2018

Earning commissions forever by simply making an introduction beats working for a living………….

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Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club

Wednesday, June 13th, 2018

Members of the 50% Club subscribe to the Upside Down Economics of Health Care. They understand those who pay on time are screwing themselves and those that don’t are rewarded…………….

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Everyone Is Paying For Mary’s Deductible Because Mary Isn’t

Tuesday, June 12th, 2018

Lucky Mary is even more lucky now that her employer decided enough was enough…………………….

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Saving Rural Hospitals By Gaming The System?

Monday, June 11th, 2018

GAMING THE SYSTEM: Remote billing by rural hospitals is becoming a strategy to remain solvent? Medicare and commercial insurers tend to pay more for tests to sustain endangered rural hospitals compared with urban hospitals and especially outpatient labs………………………………

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Medicare For All & Reference Based Pricing

Monday, June 11th, 2018

Since Medicare For All is only a few elections away some employers are asking “Why wait? Let’s do it!

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Schools Buying Insurance Against Mass Shootings On The Rise

Sunday, June 10th, 2018

McGowan Cos., the largest underwriter of “active shooter” coverage, said they’re having a tough time keeping up with hundreds of inquiries from schools and other customers……………….

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PUNISHMENT LETTER 226-J

Saturday, June 9th, 2018

The government of the United States has sent out 30,000 punishment letters to employers who have failed to comply with the ever so popular AFFORDABLE HEALTH CARE ACT…………………………..

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Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional

Friday, June 8th, 2018

Is it a tax if it raises no revenue………………………………….?

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Single Payer System Is One Election Away

Friday, June 8th, 2018

The Elephant In The Room is stirring, anxiously awaiting the fall mating season……………………….

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Accidents Of History Created U.S. Health System

Thursday, June 7th, 2018

How did Americans end up with a system in which employers pay for our health insurance? After all, they don’t pay for our groceries or our gas……………

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Welcome To The ATM World of Pharmacy

Thursday, June 7th, 2018

Pharmacist-supported self-service kiosk pharmacies ………………….

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Christian Healthcare Ministries – Alternative To Traditional Health Insurance

Thursday, June 7th, 2018

Christian Healthcare Ministries, one of several “health sharing ministries” whose members pool their resources to pay for one another’s health care expenses and has not had a rate increase in ten years……………………

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Co-Pay Tactic by Benefit Managers Credited with Cutting Prescription Drug Prices

Wednesday, June 6th, 2018

“It’s a constant cat and mouse game,” said Express Scripts Chief Medical Officer Steve Miller………………..

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Will California Criminalize PPOs?

Wednesday, June 6th, 2018

California would use Medicare rates as a floor for determining base amounts for providers and Medicare Advantage rates to set payments to health plans. Providers and health plans would be allowed to appeal for a higher amount based upon outstanding factors.

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Wellness Programs Don’t Work

Tuesday, June 5th, 2018

On its surface, who can argue with the concept of workplace wellness? How could there be anything wrong with corporations helping their employees reduce their risk of disease while saving money in the process?

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Renowned Texas Heart Transplant Program Suspends Operations

Tuesday, June 5th, 2018

Over 30% of patients who received heart transplants at St. Luke’s since the start of 2018 have died…………………………

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Drugmakers Blamed For Blocking Generics Have Jacked Up Prices And Cost U.S. Billions

Monday, June 4th, 2018

By Sydney Lupkin MAY 23, 2018

The Trump administration is shaming brand-name drug makers who refuse to sell samples so generics can be made from their products.

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Sex Sells – Winning Sales Quota by Banging Doctors?

Friday, June 1st, 2018

In 2012, Insys hired a new sales executive: Sunrise Lee, a Florida escort service manager and former strip club dancer with no academic degree, according to Guzman’s complaint. Burlakoff allegedly defended the decision, claiming, “Doctors really enjoyed spending time with her and found Sunrise to be a great listener.” He added, “She’s more of a closer.”

The regional sales manager reported that the new employee was “dumb as rocks, but that she was sleeping with another doctor and getting a lot of prescriptions out of him.” (more…)