Archive for September, 2018

Who Are A Status Quo Health Insurance Salesman’s Two Best Friends?

Sunday, September 30th, 2018

If you are a status quo broker your two best friends are………………….

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Important Decision For Reference Based Pricing Lawsuit?

Saturday, September 29th, 2018

This is a suit where the hospital alleged numerous claims against the RBP vendor and the RBP vendor responded with a motion to dismiss………………………..
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Dr. Hodad

Friday, September 28th, 2018

Every medical community has a Dr. Hodad (Hands of Death & Destruction). Peers never talk about Dr. Hodad for fear of lawsuits…………………………………………..

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Generic Substitute for $94,000 Drug To Be Released Jan. 2019

Friday, September 28th, 2018

Harvoni drug cost in the US for a three month, 84 tablet course of therapy, is $94,500. The same drug if purchased in India for example costs $900 for 3 months 84 tablet course………………

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HealthSmart Reference Based Pricing Strategies

Thursday, September 27th, 2018

Our solution pays pre-negotiated rates to hospitals and facilities at various rates of Medicare pricing…..

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The End of The Health Insurance Carrier

Wednesday, September 26th, 2018

Health insurance carriers face slow but steady disintermediation by innovative next generation benefits advisers who are using alternative funding to take control of employer health plans and reduce costs………..the beginning of the end of these dinosaurs

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Anti-Deductible Health Insurance Plans

Tuesday, September 25th, 2018

The movement away from deductibles illustrates a growing sentiment that exposing patients to more out-of-pocket healthcare costs doesn’t solve the cost conundrum and could harm patients’ health…….

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TASA Hints At Potential TRS ActiveCare Changes

Tuesday, September 25th, 2018

The 86th Texas Legislature will convene on Jan. 8, 2019. While TRS cannot speculate on specific outcomes, the Texas Legislature may make changes to the health care program. If there are changes, we will notify our members in writing.

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Turning Bronze Into Gold

Monday, September 24th, 2018

Turning Bronze Plans into Gold Plans at Bronze Plan costs is a common but unspoken strategy……………but who is benefiting from “beating the system?”

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Three Victoria City Employees Criticize Proposed Health Insurance Plan

Sunday, September 23rd, 2018

Employees’ medical claim expenditures have increased in recent years, causing the health fund to deplete so significantly that the proposed budget for the 2019 fiscal year allocates an additional $1 million for the health fund…………….

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You Can’t Fix What You Don’t See

Saturday, September 22nd, 2018

candle

“We bid out our employee health insurance every year through multiple brokers, we reduce benefits to offset rate increases, and we even light a candle 24 hours before year-end renewal!”

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Texas Association of School Administrators Advocates Alternatives To TRS ActiveCare

Friday, September 21st, 2018

TASA advocates for alternatives to TRS-ActiveCare that would provide additional options to districts while sustaining the current system for those districts that remain in the system…………..

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It Depends What The Meaning of The Word “Is” Is

Friday, September 21st, 2018

Leaked contract with Express Scripts, the nation’s largest PBM, gets crafty with its definition of “rebate.” The contract carves out so many exceptions to the “rebate” that the PBM itself ends up retaining most of the negotiated discounts for itself.

If PBMs drive up Rx costs, why use them? Why not deal directly with each pharmacy and cut the middle man out? A small Texas county is doing just that with significant savings……………..

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Selecting a Third Party Administrator

Thursday, September 20th, 2018

By William Rusteberg

With the growing suggestion that the BUCAs are inflexible third party administrators unwilling and unable to administer Reference Based Pricing plans and other strategies in the market today, more brokers are seeking new partnerships with independent third party administrators (TPA). An independent TPA can offer much more than a traditional carrier model.

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Senate Votes 98-2 to Ban Pharmacist Gag Clauses

Wednesday, September 19th, 2018

 

The Senate late Monday passed a bill that would put an end to gag clauses that bar pharmacists from telling consumers when it would cost less to pay cash for a prescription than to shell out the copayment under their health plan………………..

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Xerox, Eastman Kodak And Cost Plus Insurance

Tuesday, September 18th, 2018

trojan

“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg

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Secret Hospital Deals That Squelch Competition

Tuesday, September 18th, 2018

Contracts with insurers allow hospitals to hide prices from consumers, add fees and discourage use of less-expensive rivals………………………. (more…)

My Discount Beats Your Discount!

Tuesday, September 18th, 2018
Plan sponsors are probably the most confused group of people in the history of mankind. Every health insurance salesman that comes in the door says the same thing, “My discounts are the best!”

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Selling Fear & Cost Plus Insurance

Tuesday, September 18th, 2018

The most powerful selling tool is fear. It motivates buyers to act quickly and decisively without basis of reasoned consideration. Depending on the level of fear a seasoned salesman can gin up during his close,  fees to be charged and eagerly paid by the victim are directly and proportionally related. Higher fear levels bring higher fees.

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How Hospital Reimbursement Does and Does Not Work

Thursday, September 6th, 2018

Hospitals create chargemaster prices by multiplying the cost they pay for a product by 300 to 1200%. Another little hospital secret is what is called an outlier payment…………………….

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Anthem To Offer New Association Health Plan in Las Vegas

Thursday, September 6th, 2018

The Las Vegas Metro Chamber of Commerce announced Wednesday that it is partnering with Anthem Blue Cross Blue Shield to offer health plans to its members under a new Trump Administration rule that makes it easier for small businesses to collectively purchase insurance…………….

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Study Shows Hospitals Charge 479% of Their Cost For Drugs

Thursday, September 6th, 2018

Percentage of Charges Model – 50% Off Double The Price?

Hospitals are generally not paid 100% of billed charges; however, hospital outpatient
departments are routinely reimbursed as a percent of billed charges by commercial payers……

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Demand For Medical Debt Reduction Service At All Time High

Wednesday, September 5th, 2018

Medical debt is a problem for 39% of insured adults in this country. 1 in 8 of those are on the hook for $2,000 or more. For more than 20 years RiskManagers.us has assisted members by reducing medical debt. As more employers cost shift to their employees, demand for medical debt reduction services is at an all time high………………………………

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City Budget Hinges On Employee Health Insurance Price

Wednesday, September 5th, 2018

A Texas municipality, facing rising health insurance costs, puts annual budget on hold until employee health insurance costs are negotiated. Maintaining city services and the expense of rising health care costs at the same time is Mission Impossible. Will Tax Man come to the rescue………………………?

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MedZERO Launches in Salt Lake City in Partnership with Asserta Health

Tuesday, September 4th, 2018

Offers zero-interest funds for out-of-pocket medical expenses…………….

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Dialing For Dollars

Monday, September 3rd, 2018

They changed over my status to “self pay” which cut my $10,400 the bill by 55%…………..

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