Archive for May, 2019

PPOs and the $444 Box of Kleenex

Thursday, May 16th, 2019

Healthcare providers set astronomical, arbitrary prices, and employers and insurers have few options. But a solution is emerging. 

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Texas School District Challenges TRS ActiveCare Plan Mandates

Wednesday, May 15th, 2019

Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, the Raymondville Independent School District in deep South Texas has decided to act.

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More TRS ActiveCare Angst Among School Administrators

Monday, May 13th, 2019

Local school districts voice concern over rising costs for health coverage

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Another State Adopts Reference Based Pricing

Monday, May 13th, 2019

“To attract providers, Washington lawmakers chose a relatively high figure to start: The plan caps payouts at 160 per cent of federal Medicare rates……..”

Plan is expected to be competitive “in part to savings from a cap on rates paid to providers……………..”

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TRS Strategy To Control Health Care Costs Screws Plan Members

Sunday, May 12th, 2019

The following article reports that “TRS trustees noted the only tools available to them to address rising costs each year are to”:

  1. increase premiums
  2. lower benefits
  3. or a combination of both

Really?

Meanwhile, smart plan sponsors have solved the rising cost of health care in Texas and it ain’t by increasing premiums and lowering benefits. Rather, it’s by lowering costs and improving benefits at the same time……sounds crazy doesn’t it?

(The Texas legislature’s answer to addressing rising health care costs is House Bill 3987, that if passed, will authorize a committee to study the issue and report back in two years. But some Texas school districts are not waiting……..)

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Let The Sun Shine In…………………..

Saturday, May 11th, 2019

Health Plans Should Prepare For Plan Fallout Of HHS Rule Requiring Manufacturers Disclose Drug Prices

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El Paso ISD To Adopt Exemption To TRS ActiveCare Requirement

Saturday, May 11th, 2019

The El Paso Independent School District is set to adopt an exemption to Texas Education Code 22.004(i), which prohibits a District that has implemented employee group health coverage pursuant to Chapter 1579 of the Insurance Code (TRS ActiveCare) from providing any kind of alternative group health coverage at their May 14 board meeting.

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Too Damn HIgh!

Saturday, May 11th, 2019

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Fearless Agitator Rattles Cages For Fun

Friday, May 10th, 2019

The Real David in David & Goliath 

By David Contorno

Employers…..contrary to what you think, health insurance carriers make MORE revenue and profit as your health care costs go up. It’s federal law.

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Protection Money Scheme Dominates HealthCare

Wednesday, May 8th, 2019

Pssst…Godfather, Mulebriar Is At It Again!

“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see nor audit, violates fiduciary duties and is contrary to basic, common American business practices. “

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The Fallacy of PPO Re-Pricing Exercise

Wednesday, May 8th, 2019

Each time I see a Request for Proposals put out by insurance consultants requiring a PPO Re-Pricing Exercise in an effort to determine which network has the best discounts the temptation to reach out to Jose Cuervo is tough to ignore. 

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Who’s The Dick That’s Going To Explain Our Healthcare Tragedy?

Tuesday, May 7th, 2019

If you’re an insurance company, the simplest way to make more money, is to PAY MORE for medical services. In fact, provider negotiations should go like this:

Doctor: I want $100 for this procedure.

Insurance Company: No, we won’t pay you a penny less than $250. 

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Hospitals Are Committing Financial Suicide But Don’t Know It

Monday, May 6th, 2019

Hospitals have overplayed their hand. Galeforce blowback has arrived.

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Size Means Nothing in Health Care Financing – Common Sense Does

Sunday, May 5th, 2019

This is what a +400,000 life group plan offering status quo healthcare strategies gets you these days…………

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Reference Based Pricing Blitzkreig

Friday, May 3rd, 2019

“For-profit hospitals charge 700% more than Medicare prices, while non-profit hospitals charge 550% more. Traditional PPO plans offering a 50% discount may end up paying 300% more than the Medicare price”.  In Texas where Reference Based Pricing strategies have been around since 2007, plan sponsors are paying between 120% to 150% of Medicare…………………….The Reference Based Pricing Blitzkreig is gaining market share quickly……………

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Astute Purchasing Agent Nails It

Friday, May 3rd, 2019

A long time friend who has spent almost all of his working life in the pubic purchasing arena in Texas has a perspective that many of us in the insurance community have failed to acknowledge. 

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Grandpaw-hood At Risk?

Thursday, May 2nd, 2019

 “Please don’t leave us Grandpaw!!!”

Hey Grandpaw, I’m thinking of giving my children (your grandchildren) a few free gifts this year but I may decide later to take them back. But………. I’m worried the government will require you to disown us under penalty of sanctions!

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