Archive for October, 2018

I Don’t Care

Monday, October 22nd, 2018

“Why aren’t you gonna pay for my prescription! My doctor ordered it!!!!”

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Balance Billing Is A Plan Sponsor’s Best Friend

Sunday, October 21st, 2018

“Balance billing only occurs when purchasing  goods or services without asking  the price.”

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Uproar at Purdue

Thursday, October 18th, 2018

Employees upset with cost containment move by University officials………….“How long can we continue to offer health care coverage when we’re experiencing 20 percent to 30 percent increases on a regular basis?”

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KISS – Keep It Simple Surgery

Thursday, October 18th, 2018

The KISx Card was created as a solution for self-funded employers to tackle egregious surgical pricing while bringing simplicity to the employee experience……………….

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Blue Cross Blue Shield IL Sued for Fraud, Robbing Chicago Taxpayers

Wednesday, October 17th, 2018

Working The Spread is nothing new. Seems quite common. The article below is about a lawsuit in which spread pricing is alleged.

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Email Solicitation – To Good To Be True? You Decide

Wednesday, October 17th, 2018

We get unsolicited emails every day like the one below. This one touts a plan we have never heard of before, offering what appears to be “to good to be true” pricing. We thought we would share this for our three readers…………………….

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Paying for Coverage Without Any

Wednesday, October 17th, 2018

“What are you talking about! That’s insane” cried the HR lady. …….”I thought you needed to know” I replied.

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Chinese Government Demanding Big Discounts from Drugmakers

Monday, October 15th, 2018

The power of large numbers, 1.379 billion Chinese, brings big benefits when negotiating with drug manufacturers…………………………….

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Many Agents and Brokers Are Still Uncertain About “REFERENCE BASED PRICING”

Friday, October 12th, 2018

Breaking The Status Quo

Allied National employer groups are proving beyond the shadow of a doubt that the Freedom Plan (our reference based pricing reimbursement) is a better, lower cost, solution than traditional PPO networks.

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South Texas Health Cooperative

Friday, October 12th, 2018

Rest Easy In Our Pool

Taming Health Care Alligators Since 1998

The South Texas Health Cooperative (STHC) provides affordable health insurance to member school districts since 1998. Through careful risk management strategies, the STHC risk pool has achieved lower and stable costs while improving benefits at the same time.

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Wow! What a Difference!

Friday, October 12th, 2018
Earlier this year I moved a client from a BUCA PBM to an independent PBM. No benefit or formulary changes were made. Now that I have mature credible claim data on the move from the BUCA PBM to an independent PBM, I find Rx claims have reduced 30.1%.

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Big News! FTC to Probe Hospital Contracts

Thursday, October 11th, 2018

 

This may become the tipping point in health care reform. “The Senate Judiciary Committee chairman questions contract terms between insurers and hospital systems…………..contracts between insurers and hospital systems are limiting competition and pushing up health-care costs……………..”

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Gag Clauses Now Illegal

Thursday, October 11th, 2018

In an effort to increase drug price transparency, President Donald Trump signed two bills into law that ban insurers from writing gag clauses into their contracts with pharmacists………………

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Texas Spanks Humana – Who’s Gonna Pay For It?

Thursday, October 11th, 2018

Now let me get this straight. Humana tries and fails to negotiate a reasonable rate with enough in-network providers and is punished for it. Well, the solution is to get rid of the network and treat all providers as out-of-network. That’s what Reference Based Pricing plans do.……………..BTW guess where Humana is going to get the $700,000………………………..

– Bill Rusteberg

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Hospital Profits High In Indianapolis

Thursday, October 11th, 2018

Hospitals in central Indiana enjoy a higher profit margin than those elsewhere because they overcharge insurers…………………..

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UMMC / BCBS Squabble

Thursday, October 11th, 2018

The following article (Posted on Linkedin by Carl Schuessler) brings to mind deeper issues than the “surface” issues most consumers reading this will take away. The article hints of a gold mine of information leading to more questions than answers.

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We All Have Health Care Stockholm Syndrome

Monday, October 8th, 2018

“The Stockholm syndrome we have been suffering under is starting to break……………

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Another State Adopts Reference Based Pricing Strategies

Friday, October 5th, 2018

First it was Montana, a smallish state somewhere up north of us, who adopted Reference Based Pricing for their state health plan (Montana Adopts Reference Based Pricing Strategies). The little lady up north has big brass cojones! (Tough Negotiator Saves State Millions In Health Care).

Next there is California which is currently considering similar efforts. (California Assembly Bill 3087 Would Control Prices in the Commercial Market).

Now there is yet another state adopting Reference Based Pricing for their state employee plan. They must have heard about the little lady in Montana.

I thought Texas would lead the country on this. After all, several of us have been making noises in Austin over the past two years. Has Texas Lost It’s Cojones?.

– Bill Rusteberg

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Deductibles Hit $2,000 As Employers Intensify Cost Shift

Friday, October 5th, 2018

“Annual deductibles for Americans with employer-based health coverage are hurtling toward $2,000 on average, according to new studies analyzing employee medical benefits.”

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New England Journal of Medicine Slams Wellness Programs

Thursday, October 4th, 2018

“Outcomes-based wellness programs don’t work, so why do them?  There is no upside and therefore no argument in favor of poisoning the doctor-patient relationship. “

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Employer-Provided Health Insurance Approaches $20,000 a Year

Thursday, October 4th, 2018

Rising prices “chiefly tied to rising prices paid for health services.” Yet health care costs have remained essentially static for the past ten years. It’s the prices that have increased, not the cost of health care. – Bill Rusteberg

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San Antonio Emergency Room Raises Concerns

Thursday, October 4th, 2018
San Antonio’s newest Emergency Room service sparks interest among residents and government officials.  The Emergency Room “is not even open for business but is already causing controversy.”

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Tough Negotiator Saves State Millions In Health Care

Tuesday, October 2nd, 2018

 Marilyn Bartlett

Marilyn Bartlett took a deep breath, drew herself up to her full 5 feet and a smidge, and told the assembled handful of Montana officials that she had a radical strategy to bail out the state’s foundering benefit plan for its 30,000 employees and their families………………..

Will Texas be next?

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An Electrical Physical? How Much Is That?

Monday, October 1st, 2018

“No, I am not doing an electrical physical, I’m here for a cold and I don’t need that test!” ……“But sir, your Blue Cross will cover it” came her soothing reply.

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