Archive for November, 2018

Austin, Texas Sick Pay Leave Unconstitutional

Wednesday, November 21st, 2018

Judiciary says it’s unconstitutional, so legislators  have developed a cure of their own………….

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More Employers Are Leaving Fully Insured Plans………………

Wednesday, November 21st, 2018

“To gain control over the ever-increasing cost of employee health insurance, more and more employers are discontinuing their fully insured coverage and switching to self-funded models.”

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Health Care Ate America

Wednesday, November 21st, 2018

In the five decades after the passage of America’s two largest health care entitlements, that sector has become a maw, eating everything in its path. Health spending has reshaped the nation’s job market, its household finances, and its public budgeting…………………..

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Ending American Greed?

Wednesday, November 21st, 2018

“The greed of the prescription drug industry is literally killing Americans and it has got to stop…..”

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Texas School District Seeks To Exit TRS ActiveCare

Tuesday, November 20th, 2018

Once enrolled on the TRS ActiveCare health plan, school districts are forever prohibited from leaving. There are no exceptions permitted. Or are there?

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BenefitMall

Sunday, November 18th, 2018

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Merloch Coins New Term For Reference Based Pricing

Sunday, November 18th, 2018

Michael Meloch, President of TPAC Underwriters, comes up with a new term for Reference Based Pricing in a Phia Group podcast…………………………..

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Blues Plans Enjoy Record Profits

Saturday, November 17th, 2018

Blue Cross Blue Shield plans have collected billions of dollars in profit in the first six months of this year………………………….Premiums have vastly outpaced the claims that the health insurers had to pay out to hospitals and doctors……………..

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Pfizer to Raise Prices on 41 Drugs in January

Saturday, November 17th, 2018

   “Drug Costs Are Too Damn High”

As long as consumers purchase drugs with other people’s money big pharma knows consumer (market) blow back from pricing increases will be minimal……..

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Allied National Returns Unused Claim Dollars To Clients

Friday, November 16th, 2018

Allied National’s Funding Advantage contract returns unused claim fund dollars to employers who have favorable claims experience!

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I’m A Reformed Broker – Having Second Thoughts Is Not Possible…………

Wednesday, November 14th, 2018

Making $2 million on an 8,000 life Texas school district is really easy. I know because it’s been done, even as we speak…………………..

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AWP – Ain’t What You Pay

Wednesday, November 14th, 2018

INSIDE AWP: THE ARBITRARY PRICING BENCHMARK USED TO PAY FOR PRESCRIPTION DRUGS

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One Man’s Experience with Free Market Medical Care in the U.S.A.

Wednesday, November 14th, 2018

What’s ironic about this story, is this is exactly how we’d do it if our dog needed knee surgery…….

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Battle For Patient’s Wallet Moves To EHR

Wednesday, November 14th, 2018

“The only party not taken into consideration is the employer who is on the hook for the vast majority of the cost of drugs that will be sold through this channel……………….”

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Providers Push Back – N. Carolina Treasurer Pushes Back Harder

Tuesday, November 13th, 2018

“It doesn’t matter who the governor is, or who controls the legislature. It’s not political. It’s mathematical.”

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Jury Hits Aetna With $25 Million Judgement

Monday, November 12th, 2018

“Aetna pays its ‘medical directors’ bonuses for increasing the company’s profits by denying claims…….”

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Final Regs – Exemptions from Contraceptive Coverage Mandates

Monday, November 12th, 2018

Government continues to interfere in citizen’s sex lives……………………..

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Memorial Day 2018

Sunday, November 11th, 2018

 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 to Defend an ERISA Lawsuit

Sunday, November 11th, 2018

Firestone deference – Many ERISA plans use plan document language stipulating the plan administrator has the authority to interpret plan terms and resolve any ambiguities. The United States Supreme Court has held that when a plan contains this language, courts must show deference to the administrators and review their decisions under an arbitrary and capricious standard…………….

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Healthcare Waste is Costing Billions…………

Saturday, November 10th, 2018

………………and clients aren’t doing anything about it

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Sun Life Tops Market Expectations

Friday, November 9th, 2018

Business strategy is to focus on four pillars of growth: the Canadian home insurance and wealth market, US group benefits, global asset management, and distribution excellence in higher growth markets in Asia…………………………

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90+ Medications To Be Dropped by Insurance in 2019

Friday, November 9th, 2018

Drugs excluded includes brand-name drugs for which less expensive brand or generic alternatives are available in the market…………………………………..

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GR Data Insights: MSK – Quality matters………………

Thursday, November 8th, 2018

Grand Rounds is focused on reducing high cost claimants and improving patient outcomes and we have tangible evidence to prove it……………………

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Here Comes The Judge

Thursday, November 8th, 2018

 

 

He’ll give you time if you’re big or small
All in line for this court is neat
Peace brother, here comes the Judge 
Here comes the Judge…………………………………….

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Gridlock Sets In……………….

Thursday, November 8th, 2018

With a Democratic House, a Republican Senate, and President Trump in the White House, get ready for two years of maneuvering but little progress on health care…………..

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State of Utah Fights High Drug Prices With Results

Thursday, November 8th, 2018

The savings are anywhere between 38% to 75% well may save the state millions each year……..

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CMS Delays Dramatic Office-Visit Coding Changes Until 2021

Tuesday, November 6th, 2018

Proposed changes would have increased CPT 99213 by 30%……………..Primary Care Physicians lose out on pay raise. 

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Sunday, November 4th, 2018

How do you know if your surgeon is the best of the best or the worst of the worst? Unfortunately most patients play Russian Roulette when it comes to picking one………………….the results can be hazardous  to your health…………..

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More Texas Doctors Switch To Concierge Medicine Model

Sunday, November 4th, 2018

More doctors in Texas plan to make the switch to primary care out of frustration with the current healthcare system…………………………….

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Employers Are Becoming More Active in Healthcare Claims Management

Friday, November 2nd, 2018

“Employers are cutting out insurers completely and contracting directly with providers and/or creating near-site or on-site health clinics for primary care……………….More traditional cost management techniques are simply running out of gas. Employees, who have borne half of recent-year cost increases, simply can’t afford anymore,”

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San Patricio County Seeks Stop Loss Insurance

Friday, November 2nd, 2018

San Patricio County is seeking competitive specific stop loss proposals for a January 1, 2019 effective date. This 400 life case has been on Reference Based Pricing for the past ten years and does not access any managed care networks.

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