Archive for June, 2019

Lawsuit Alleges Rx Price Fixing

Sunday, June 30th, 2019

Lawsuit alleges Rx price fixing – read Summary for a synopsis……………..

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Unintended Consequences?

Friday, June 28th, 2019

“340B is a well-intentioned drug discount program gone awry………..” Has the program departed from its statutory foundation?

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Senate Panel Makes Surprisingly Fast Work of ‘Surprise Medical Bills’ Package

Thursday, June 27th, 2019

“Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns.

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The New HRA Program Is NOT Good for Us

Thursday, June 27th, 2019

A benefits veteran has read the new final regulations. He’s not impressed.

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The High Price of Hospital Care

Wednesday, June 26th, 2019

HOSPITAL PRICES ARE TOO DAMN HIGH!

Several states have implemented forms of reference pricing for public plans…………..

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Brownsville ISD Awards Insurance Consulting Contract

Wednesday, June 26th, 2019

“The recommendation of this agenda is to recommend to the Board of Trustees the firm that will provide the best value as the Consultant to help guide the district in reviewing options related to our employee benefits program.”

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California Legislature OKs Health Insurance Mandate

Tuesday, June 25th, 2019

California to punish (tax) citizens who don’t buy health insurance but will not punish (tax) illegal immigrants. Instead California will provide government funded (taxpayer paid) health insurance to low income young adults coming from anywhere on the planet and living in the U.S. illegally.  (See California – Free Health Insurance For Planet Inhabitants).

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When Patients Can’t Pay, Many Hospitals Are Suing

Tuesday, June 25th, 2019

Politicians want to rein in aggressive tactics used by nonprofit hospitals to collect unpaid bills, including suits and garnishing of wages………….

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About RiskManagers.us

Tuesday, June 25th, 2019

The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

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Reference Based Pricing California Style

Monday, June 24th, 2019
California Assembly Bill No. 72  – OUT OF NETWORK REIMBURSEMENT

Texas School District Chaffs Under Government Health Plan

Sunday, June 23rd, 2019

House Bill 3987 was filed this session to create a committee to review health benefits from TRS, but the bill did not move past the House Pensions, Investments & Services Committee.

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Second Texas School District Challenges TRS ActiveCare Mandate

Saturday, June 22nd, 2019

The El Paso Independent School District (EPISD) is the second Texas public school district ( See Texas School District Challenges TRS ActiveCare Plan Mandates) to challenge TRS ActiveCare by offering district employees a choice between the state sponsored program and a commercial health plan alternative.

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President Trump to Issue Executive Order on Health Care Price Transparency

Saturday, June 22nd, 2019

HOSPITAL ADMINISTRATORS REACTS

Hospitals and insurers say they are against the idea of transparency. Sunshine adverse, these pasty faced third party intermediaries say transparent pricing will lead to increased costs. That must mean the cost of goods and services in this country can be reduced by adopting health care pricing strategies of Don’t Ask And We Won’t Tell!

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Gateway to Health Care: The Clerk In The Cubicle

Saturday, June 22nd, 2019

The way out of this mess is for Americans to remove themselves from the health insurance market altogether—or to participate in other forms of health insurance such as health sharing ministries and short-term insurance plans. Individuals can actually pay a doctor, hospital, or outpatient center for a service performed without filing claims or getting pre-approval from a clerk in a cubicle.

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It’s Xmas In Texas – State Passes “No Credit Ding Law”

Friday, June 21st, 2019

Major boon to Reference Based Pricing plans…………………..

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Will Senator Ted Cruz Come To The Rescue?

Thursday, June 20th, 2019

Frustrated by a lack of response to our previous inquiries among numerous sources we approached (including several well known benefit experts) in seeking a definitive answer to a burning ACA question we have, it was decided by staff to attempt one last hopeful effort in peeling back the regulatory onion in search of the truth. Will Ted and his staff come to the rescue?

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Little Ole Gran Ma From Little Ole Montana Teaches The Big Boys A Lesson or Two

Thursday, June 20th, 2019

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Direct Hospital Contracting

Thursday, June 20th, 2019
“Only about 3 percent of self-insured companies nationally have some form of direct contracts with providers, said the National Business Group on Health.

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Game of Chicken – North Carolina Style

Wednesday, June 19th, 2019

Hundreds of millions of dollars and medical care for more than half a million people are at stake in what amounts to a game of chicken over a cut in how much the largest health insurance plan in North Carolina pays for care.

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Senators Avoid Agent Comp Topic at Health Cost Bill Hearing

Wednesday, June 19th, 2019

A major new health care and health insurance cost control bill still includes a long agent and broker compensation provision — but senators don’t seem to be eager to talk about it.

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Why Can’t I Get A Total Price On My Healthcare Procedure Before I Go?

Tuesday, June 18th, 2019

Thomas Farmer

“It looks like we are entering the “shipping & handling” awareness phase of healthcare costs.”

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Was J Patrick Rooney Right?

Monday, June 17th, 2019

Purveyors of Reference Based Pricing strategies can’t seem to agree on what the reference benchmark should be. Thirteen years ago J. Patrick Rooney (1927-2008) said it was 125% of Medicare. Was he right?

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Dendy Opines on North Carolina RBP Fiasco

Monday, June 17th, 2019

The state of North Carolina has received considerable push back from the medical community in their efforts to reign in rising health care costs for public employees. Scheduled to implement Reference Based Pricing strategies beginning January 1, 2020, the state’s medical industry (primarily hospitals) have pushed back so hard there is now doubt the plan will ever take effect. 

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 John W. Sbrocco

Friday, June 14th, 2019
John W. Sbrocco, CSFS
Healthcare Consultant helping self-funded employers evacuate & reduce medical claims.

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Sharing Plans Gaining Market Traction

Friday, June 14th, 2019

Sharing plans are not new. They have been around for years. While not insurance, these programs can offer affordable access to health care.

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Hungry? Free Lunch in San Antonio June 19!

Thursday, June 13th, 2019

HealthComp Hosts “Lunch & Learn” with H-E-B and Baptist Integrated Health Partners in San Antonio

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Will Judge Demand Marriage Annulment?

Wednesday, June 12th, 2019

Some marriages are just not meant to be…………………..

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Medicare-For-All Gaining Support Among Businesses?

Monday, June 10th, 2019

“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction………”

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The Best Discounts In Health Care Are Not Through Your Health Insurance Company

Saturday, June 8th, 2019

 

 “How Much Did You Say That Xray’s Gonna Cost?

A little ole housewife with cash in her purse has more bargaining power than Blue Cross, United HealthCare and Aetna combined………………………

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San Antonio Flu Epidemic Season Is Winter, Spring, Summer & Autumn

Friday, June 7th, 2019

It pays to be sick in San Antonio and Dallas these days………………………

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Recent Trends in Stop Loss Claims

Friday, June 7th, 2019

SOURCE: Frenkel Benefits

“The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims.

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Survey Reveals “Me Too” Brokers In The Majority

Thursday, June 6th, 2019

“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”

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One Election Away From Free Single Payer System

Wednesday, June 5th, 2019
Successful pandering to gain voters is best achieved by promising free stuff. Each national election we end up getting more free stuff. And we haven’t yet run out of other people’s money…..Hallelujah!

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If We Don’t Fix Health Care Big Government Will

Wednesday, June 5th, 2019

There has not been a competitive health care market for years. Managed care contracts have contributed to that. Some employers have fixed health care buy most haven’t. This blog has written about the former in the past so if you are a regular reader you know exactly what we are talking about.

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2020 HSA and ACA NGFP Limits

Tuesday, June 4th, 2019

Government control of health care (a precursor to a single payer system) continues to manifest itself with constant dictates from bureaucrats in Washington. . The newest and latest message from the swamp is “we’ve placed a new limit on what you can save tax free towards your personal healthcare……………….” Our in-box receives numerous daily updates like the one below:

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Health Care Financing 101

Monday, June 3rd, 2019

Massachusetts hospitals stash $1,600,000,000 in offshore accounts…………….

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MediBid is Pleased to Announce Its New Medicare Allowable Lookup

Sunday, June 2nd, 2019

                  Ralph Weber 

Ralph says bundled health care pre-negotiated cash pricing comes in at an average of 108% of the Medicare rate.  That’s a very good number in case you’re wondering………………. 

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