Archive for April, 2019

Texas House Bill 3933 – A Panacea for Reference Based Pricing Plans?

Tuesday, April 23rd, 2019
The Texas legislature is considering numerous bills of interest to those of us engaged with health care delivery in this state. HB 3933 is one, that if passed, will have a considerable impact upon the health care community.

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Webb County Seeks P&C Insurance Consultant

Tuesday, April 23rd, 2019

RFQ 2019-0006 Package for a Consultant for Health Insurance for Webb County can be obtained from our EBid site located at:  https://webbcountyebid.ionwave.net/CurrentSourcingEvents.aspx

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PBM’s

Tuesday, April 23rd, 2019

Going Broke? Never Mind, Just Print More Money

Monday, April 22nd, 2019

Trustees project Medicare trust fund will be depleted in seven years………..So let’s do Medicare For All and see if we can go broke faster……………………………Never mind. Sam, fire up the ole printing press will ya………..we’ed be needing some money to pay for all this.

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Disruptive Digital Business Models For Health Insurers

Monday, April 22nd, 2019

“The main impact of digital business models is on company evaluation, which reflects the hype that some companies have created in the investor community. Companies like Oscar, Clover Health, and Bright Health are valued at over $1 billion USD each after only a few years of operation.”

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Texas Considers Balance Billing Legislation For Self-Funded Plans

Sunday, April 21st, 2019

At first glance Texas Senate Bill 1530 looks appealing. Balance billing protection for self-funded health & welfare plans would be a welcomed gift from government, especially among purveyors of Reference Based Pricing plans. 

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33% of U.S. Workforce Using Prescription Pain Medications

Thursday, April 18th, 2019

      Morning Shift Arriving At Work

One in three workers reported using prescription pain relievers — the majority under treatment of a physician………………………

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The Antithesis of Managed Care

Thursday, April 18th, 2019

Insurer Paid +300% of Medicare But The Discount Was Really Good

Thursday, April 18th, 2019

In the article by Marshall Allen that follows patient questions why Aetna paid  a grossly inflated rate of more than 300% of Medicare for his in-network claim. Well, that’s not the way Aetna or any other managed care company wants you to look at it. Instead they want you to focus on “discounts.” Managed care companies like Aetna reinforce that focus by sending patients EOB’s highlighting those amazing and magnificent discounts applied against billed charges. Could it be you may be looking at a 50% discount off double the price?

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Health Insurance Hustle

Thursday, April 18th, 2019

Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose

The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.

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The Death of PPO’s

Wednesday, April 17th, 2019

PPO’s are a fraud and more are beginning to understand that. The only thing PPO’s can guarantee is the promise of no balance billing. That’s a powerful and effective coercive method used to foster obedience to status quo strategies of the past 35 years.  However, the truth is we are all running out of money to fuel the American Healthcare Monster. Breaking away from status quo solutions will soon become a national epidemic of fundamental change bringing sanity to health care costs in this country – Bill Rusteberg.

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Reason & Logic Won’t Move TRS ActiveCare Trustees

Tuesday, April 16th, 2019
TRS ActiveCare Plan Manager Struggles To Save Program
“It’s impossible to prove something to someone whose salary depends on believing the opposite” – Upton Sinclair

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Another Win For The Oklahoma Medical Association

Tuesday, April 16th, 2019

We’re excited to have a contract for services with the Texas Free Market Surgery Center. Our Texas clients who join the Oklahoma State Medical Association (OSMA) health plan will now have access to bundled pricing in Austin, Texas.

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Fully Insured Dental Plan Request for Proposals

Monday, April 15th, 2019

McAllen Independent School District (the “District”) invites your submittal on: RFP No. 2018-200 – Fully Insured Dental Plan…………………….

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Adverse Selection Dooms TRS ActiveCare

Monday, April 15th, 2019

The TRS ActiveCare plan for Texas school districts is imploding. Many want out of the program…….

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Scientist Proves Employee Benefit Meetings Are A Waste of Time

Saturday, April 13th, 2019

The Ebbinghaus Study is widely accepted as a definitive study in human intelligence. The study concluded that within 24 hours we will forget 75% and within 30 days we will forget 90%. The remaining 10% will remember only 5%.

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Why Do Some Fiduciary Violations Go Unpunished While Others Result in Jail

Friday, April 12th, 2019

“People are going to jail over ERISA fiduciary violations and the dollar amounts pale in comparison to what is being wasted on the employee health plan side of ERISA.”

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Is Medicare Supplemental Insurance Worth It?

Friday, April 12th, 2019

Dr. Dave opines again on Medicare supplemental insurance policies…………….

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RBP Market Growth Continues – Blue Cross Adopts No Network Model

Thursday, April 11th, 2019

 

The North Carolina Blue Cross Blue Shield “My Choice” policies aim to change the way doctors and hospitals are paid by limiting reimbursement for services to 40% above what Medicare would pay. The plan has no network of doctors and hospitals…………………

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Hospital Insults Plan Sponsor – Wants 1,947% of Medicare

Tuesday, April 9th, 2019

Hospital demands almost 2,000% of Medicare to settle claim………………….

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Health Insurance Bankrupting Americans – Personal Debt Reaches New Highs

Monday, April 8th, 2019

A new survey from Gallup shows that Americans borrowed a staggering $88 billion in 2018 to pay for health-care costs that were not covered by their insurance plans………..….

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Cancer Cure?

Monday, April 8th, 2019

Activated immune cells travel throughout the body, killing tumors wherever they find them…………….

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Surprise Medical Bills – Two Texas Physicians Respond

Monday, April 8th, 2019

“Conditions and diseases of healthcare systems which are relevant to this discussion include: incentive malalignment syndrome, hypermetricosis, benefit managementosis, maladaptive dysdocumentosis and more.” – Texas Physician

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3 Ways Employees Can Reduce Prescription Costs

Monday, April 8th, 2019

Senator Cruz Proposes 4th Method To Reduce Drug Costs?

In an unprecedented move, Tx. Senator Ted Cruz introduces Senate Bill to free the worlds most successful drug importer. “Chapo has proven cheap and effective drug importation is possible! With his direct-to-source plus vast American distribution system, El Chapo, his organization has the where with all to help solve our broken health care delivery system. FREE CHAPO!

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InstaMed

Sunday, April 7th, 2019
Creating electronic movement of healthcare data and money faster than a melting Raspa …………..

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Doctors Practices Leaving Charlotte Hospitals Catch The Eye Of Their Industry

Sunday, April 7th, 2019

By Alex Olgin  Mar 25, 2019

For the more than 40 doctors at Lakeside Family Physicians and Huntersville OB/GYN, the move away from Novant Health is a return to how they used to practice medicine. Both groups were independent before joining with Novant about 15 years ago.

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Employers Get Choosier About Workers’ Doctors

Saturday, April 6th, 2019

Many big companies are mining data from their own health plans and public records and working with consultants to compare physicians, searching for those with the best results and competitive costs.

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A Million Views in 44 Days! ClearHealthCosts Price Transparency TED Talk Goes Viral

Saturday, April 6th, 2019

Jeanne Pinder scores big with TED talk…………………….

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Status Quo Consultants vs New Age Consultants

Thursday, April 4th, 2019

By Bill Rusteberg

Last year I had the privilege to make a presentation to the Board of Trustees of a Texas independent school district. The district’s self-funded health & welfare plan was in trouble and they wanted to hear how we have been able to keep costs static over time for other school districts we have been fortunate enough to manage over the past twenty years. Those districts have beaten medical trend while improving benefits at the same time and at half the cost.

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Outrage Over Rising Costs of 100 Year Old Drug

Wednesday, April 3rd, 2019

Insulin manufacturers and PBMs have faced mounting pressure amid outrage over the rising cost of insulin, a nearly century old lifesaving drug.

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Clarity Benefit Solutions – TPA for Tax Advantaged Plans

Wednesday, April 3rd, 2019

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Clarity Benefit Solutions is a broker-friendly benefits technology company and TPA for Tax-Advantaged Plans with 25+ years of industry experience.  Our easy-to-use programs and tools are designed to innovate, integrate, and automate – taking the frustration out of benefits with solutions that actually work.

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How Two Common Medications Became One $455 Million Specialty Pill

Wednesday, April 3rd, 2019

You can walk into your local drugstore and buy a month’s supply of Aleve and Nexium for about $40. For Vimovo, the pharmacy billed my insurance company $3,252.

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DOL “End Run” Ends In Defeat

Wednesday, April 3rd, 2019

Stringent government control of health care continues to defeat efforts of free market proponents……………….

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Texans Support Consumer Protection Laws Against Medical Price Gouging

Tuesday, April 2nd, 2019

Texas Free Standing Emergency Rooms (FSER) resemble urgent care centers, but on average, an FSER costs 10 times as much as an urgent care visit for the same condition……………..

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New PHI Procedure

Tuesday, April 2nd, 2019

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