Archive for February, 2019

Insulin Makers Face Drug Pricing Suit

Friday, February 22nd, 2019

Price of Drugs Is Too Damn High!

“This ruling blows the insulin racket wide open,’’ said Steve Berman, a plaintiffs’ lawyer who is one of the leaders of the potential class-action case. The ruling “clears the way for us to begin obtaining discovery from the manufacturers and PBMs so we can shine the light on exactly what has driven insulin prices sky-high,’’ he said.

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Primary Care – The Future of Employee Care?

Friday, February 22nd, 2019

“Direct primary care (DCP) — a fee-based model that gives individuals unlimited access to a primary care doctor for anywhere between $60 to $150 a month, without insurance being billed — is the “future of healthcare….”

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New MEWA in Texas Announced

Thursday, February 21st, 2019

Last month, we received our license to sell Association Health Plans (AHPs) to medical groups in Texas through the Oklahoma State Medical Association (OSMA). They have a proven track record of providing significant savings to their members and offer a broad range of health plans.

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How You Can Save On Health Care in Texas

Thursday, February 21st, 2019

Just like 4.3 million other Texans, they have zero health coverage. They simply cannot afford health insurance. “We don’t have health insurance because it’s just outrageous. We have to choose food or clothing over health insurance, and food and clothing are just going to come first,” Kevin Doetticher said.

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Jeanne Pinder On TED Talk

Wednesday, February 20th, 2019

My TED talk is up! 

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Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans

Wednesday, February 20th, 2019

 Industry wide, transparency is not the standard. ProPublica sent a list of questions to 10 of the largest broker agencies, some worth $1 billion or more, including Marsh & McLennan, Aon and Willis Towers Watson, asking if they took bonuses and commissions from insurance companies, and whether they disclosed them to their clients. Four firms declined to answer; the others never responded despite repeated requests.

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TO UNDERSTAND VALUE’S MARKET PROGRESS, WATCH PRIMARY CARE

Tuesday, February 19th, 2019

Brian Klepper

“Renegade PCPs long for independent practices where their patient care decisions are not so influenced by their employers’ interests……………….By recapturing control of care and cost, they also are re-establishing primary care’s primacy within health care……………..”

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Debunking The Stagnant Wage Myth

Monday, February 18th, 2019

“In 60 seconds, this CEO explains why healthcare has blocked many manufacturing jobs from coming back to the U.S.” – Dave Chase on Linkedin………………..

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How Dare You! 177% of Medicare Is Insulting!

Sunday, February 17th, 2019

The state of North Carolina has adopted Reference Based Pricing for their state employee benefit program to become effective in 2020. The reference price will be pegged at 177% of Medicare. That has caused an uproar with the state’s hospitals and they are fighting back hard.

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McAllen ISD To Interview Top 3 Consultant Finalists

Sunday, February 17th, 2019

By Molly Mulebriar

McAllen Independent School District in deep South Texas is set to interview the top three finalist for the district’s insurance consultant position this week. MISD employee benefit program is self-insured and administered by Blue Cross & Blue Shield.

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Texas Medical Association Highlights Reference Based Pricing

Saturday, February 16th, 2019

“It’s an intriguing way to lower costs for both physicians and health plans, and it could reduce premiums for patients. It also could enable doctors to wrestle more contract-negotiating leverage out of the hands of the market’s dominant health plans ― and in some cases, contracting with them might not even be necessary.”

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American Health Care – The Economic Trojan Horse of Destruction

Saturday, February 16th, 2019

“We are taking that wasted money and artificially inflating the cost of health care to the point that nobody can afford it without government continuing the death spiral of spending, monopolizing, and price inflation.”

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Reference Based Pricing

Thursday, February 14th, 2019

In this video, Dr. Eric Bricker Explains Reference-Based Pricing.

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Reasons For Having A Primary Care Physician

Thursday, February 14th, 2019

Dr. Eric Bricker Explains 3 Reasons for Having a PCP: 1) Screening, 2) Same-Day / Next-Day Appointments and 3) After-Hours Call-In Access.

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Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design?

Tuesday, February 12th, 2019

In contrast to deductibles, where the patient pays the “first dollar” of medical expenses, under RBP, the patient is responsible for the “last dollar.”

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The Great Free Standing ER Scam Continues…………………

Tuesday, February 12th, 2019

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Catholic Diocese Insured Against Child Sexual Abuse Claims

Monday, February 11th, 2019

Liberty Mutual has agreed to pay the Diocese of Duluth US$6.5 million under a recent settlement agreement over litigation of insurance coverage for child sexual abuse damages………..

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Greenlight Re invests in Texas-based TPA

Sunday, February 10th, 2019

Greenlight Re Innovations, part of specialist property and casualty insurer Greenlight Capital Re, has announced an investment in Sana Benefits, a Texas-based third-party administrator (TPA) focused on the self-insured health market……………...

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$1,000,000,000.00 Insurance Scam

Sunday, February 10th, 2019

Four men and seven companies have been charged in connection with a $1 billion healthcare scam, according to the Department of Justice………………….

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AccuRisk Solutions LLC

Sunday, February 10th, 2019

AccuRisk Solutions LLC is a Chicago-based Managing General Underwriter focused on providing its producers with innovative insurance products and outstanding customer service.

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Mexican Drug Run

Sunday, February 10th, 2019

“It’s cheaper for us to pay for the drug down there, send them down there and then give them $500….”

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Japan Post Eyes $2.6 Billion Investment in AFLAC

Sunday, February 10th, 2019

Japan Post would like to expand Aflac’s cancer insurance products sold at post office counters…..

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Kratom Anyone?

Friday, February 8th, 2019

Kratom is a miracle cure for everything from opioid addiction to anxiety……..

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Nataline Could Have Been 28 Today If Not For A Health Insurance Decision

Friday, February 8th, 2019

I’ve been asked many times if there was one thing, one moment, that led me to leave my job at a big health insurance corporation. Yes, there was, and it occurred five days before Christmas in 2007. That was when a beautiful 17-year-old girl named Nataline Sarkisyan passed away, days after the company I worked for refused to pay for a liver transplant that her doctors believed would save her life. A few days after Nataline’s death, I turned in my notice.

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Climate Change & Employee Benefits – Are You Kidding Me!

Friday, February 8th, 2019

If your’re in HR and believe in climate change this article is for you. You may want to consider offering your employees energy-free light bulbs and mandate car pooling………….

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Insurance Denials Can Be Death Sentences

Friday, February 8th, 2019

                  Molly Fetzer

Self-funded school district overrides TPA’s (Anthem) decision to deny coverage and authorizes doctor ordered treatment plan for stage 4 cancer member………………….

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Patient Sentenced To Death?

Thursday, February 7th, 2019

Putting dollars in front of saving lives……………………..?

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Sheryl Bonner 1963-2019

Wednesday, February 6th, 2019

Respected industry leader passes………………………

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Why Employers Should Work With Older Folks

Wednesday, February 6th, 2019

“I’m 67, so I could give a shit,” she says. “What are they going to do, fire me? I’m packin’ a Medicare card.” – Marilyn Bartlett

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USA Rx Revolt Looks To Canada For Help

Tuesday, February 5th, 2019

Colorado on Thursday joined a growing number of states that want to cut certain prescription drug prices by importing licensed drugs from Canada………………..

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Gotta Love Bernie!

Tuesday, February 5th, 2019

Bernie Discovers Self At Early Age

Senator Sanders asks why drug, once free, now costs $375,000,000.00…………..

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HRA’s To The Rescue!

Tuesday, February 5th, 2019

The HRA’s Are Coming!

Expands the use of HRAs to allow for the purchase of individual health insurance coverage…..

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Centenarians Rejoice

Monday, February 4th, 2019

Hawaii considers ban on cigarette sales except for centenarians…………………..

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Cigna’s $54 Billion Problem

Sunday, February 3rd, 2019

Health insurer’s purchase of Express Scripts is looking like even more of a blunder……..

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The Prevalence of Self-Funded Health & Welfare Plans

Sunday, February 3rd, 2019

With steady growth in the last four decades, self-funded plans are now the most common type of health plan that workers are enrolled in across the United States. Various sources put this number at nearly 70% and climbing. Nearly all self-funded employee benefit plans are managed through a third party administrator (TPA) firm, an independent organization that assists with overall plan operations, benefit coordination and claims processing.

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