Archive for August, 2019

Beginning of The End of Group Health Insurance?

Tuesday, August 20th, 2019

Will HRA’s replace group medical plans?

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$0 Investment Brings $2.4 Million Annual Return

Monday, August 19th, 2019

Is it true a South Texas Hospital system is buying up primary care practices to fatten up their cash cow?

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The ‘follow-up appointment’

Sunday, August 18th, 2019

For many people in medical debt, a trip to the emergency room leads to the courtroom


Wenzle Hufford, 76, uses a rope to tow his wife, Lucynda, with his motorized wheelchair in Kennett, Mo. Both have large medical debts. His legs were damaged when he was hit by a car; she has diabetes and heart problems. (Michael S. Williamson/The Washington Post)

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The Misconception of Risk Pooling

Saturday, August 17th, 2019

By Bill Rusteberg

As members of the +400,000 member TRS ActiveCare risk pool “The Power of Large Numbers” and “Economies of Scale” bring comfort to small Texas school districts . “We could not get comparable coverage on our own, much less at affordable rates” is the mind thought of school district officials throughout the state.

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San Antonio Suspends Paid Sick Leave Law

Friday, August 16th, 2019

“San Antonio has agreed to delay implementation until December 1, 2019. The stay will allow time for guidance from the Texas Supreme Court on the law’s constitutionality. In the meantime, San Antonio’s Paid Sick Leave Commission has agreed to work with business stakeholders to recommend changes in the ordinance to the San Antonio City Council.”

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Hospital Bills 1661% of Medicare

Friday, August 16th, 2019

Hospital billed charges total 1661% of Medicare. A typical PPO “discount” would be between the range of 50-70%. If the later, the hospital would be paid about 498% of Medicare. Plan paid 180% of Medicare. Hospital still wants more money. Plan sponsor says “Not in my lifetime!”

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The Cost of Convenience

Friday, August 16th, 2019

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

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Selecting a Third Party Administrator

Friday, August 16th, 2019

By William Rusteberg

With the growing suggestion that the BUCAs are inflexible third party administrators unwilling and unable to administer Reference Based Pricing plans and other strategies in the market today, more brokers are seeking new partnerships with independent third party administrators (TPA). An independent TPA can offer much more than a traditional carrier model.

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Thursday, August 15th, 2019
“Those trying the preserve the wildly under-performing and bankruptcy-inducing status quo healthcare system will do whatever it takes to try to thwart progress” – Dave Chase

Why Some Doctors Purposely Misdiagnose Patients

Thursday, August 15th, 2019

In his time at the hospital, from 1999 to 2007, his salary rose from$185,000 to $300,000, and he qualified for bonuses up to $220,000 if he met certain billing targets.

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Off The Record

Thursday, August 15th, 2019

By Bill Rusteberg

While visiting Washington DC last year on business, I ended each day with a short visit to Off The Record, a bar located at the Hay Adams Hotel across the street from the White House. This place is always packed with interesting people and I had occasion to meet a few of them. 

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Wednesday, August 14th, 2019

Texas and Colorado issue cease and desist orders to health care sharing ministry………

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Hospital Administrator Morphs Into Insurance Sales

Wednesday, August 14th, 2019

See hospital administrator morph into an insurance broker before your very own eyes…………….From Hospital administrator to power broker in under five minutes…..

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Health Insurance Choices Could Get Your Client Deported

Wednesday, August 14th, 2019

New immigration regulations leave coverage purchased with ACA subsidies off the list of positives.

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Brownsville ISD Insurance Commttee

Tuesday, August 13th, 2019

If you are a new era health insurance consultant this video will drive you nuts.

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To Save Money, American Patients And Surgeons Meet In Cancun

Tuesday, August 13th, 2019

A knee replacement surgery costs an average of about $30,000 at U.S. hospitals, but only $11,000 at Galenia Hospital in Cancun, Mexico.

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North Carolina Caves – Hospitals Win Big

Sunday, August 11th, 2019

“By spending millions of dollars to oppose us and by using cartel-like tactics, these organizations were able to convince most hospitals to boycott the State Health Plan,” said Treasurer Folwell. “If big hospitals could do this to their largest customer, just think what they can do to the individual average citizen or business.

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Private Payers Pay 2.7 Times on Average What Medicare Pays Hospitals

Sunday, August 11th, 2019

With the lid ajar on Pandora’s box, we are likely to see employer demands pegged to price transparency and more strategies built on provider prices.

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The Phia Group Launches Newest Service: Patient Defender

Sunday, August 11th, 2019

Health plans, TPAs, and brokers can now contain costs while knowing that patients have a legal advocate standing by.

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Recent Health Plan Practices That Are Resulting in Underpayments to Providers

Saturday, August 10th, 2019

“Anthem is determining whether an outpatient MRI, CT scan, or PET scan is “medically necessary” based on where the service is performed.”

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Do Hospitals Charge More to Make Up for Low Government Pay?

Friday, August 9th, 2019

Answer: “NO”. Hospitals charge as much as they can get away with…..

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Risk Payment Models

Friday, August 9th, 2019

Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses………………..

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Health Care Is Gobbling Up Your Wages

Thursday, August 8th, 2019

SOURCE: Axios

“In 1999, the average health insurance coverage for a family consumed 14% of the average household income …  By 2017, family coverage absorbed more than double that amount, to about 31% of take-home pay.

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Union Urges School District To Consider New Era Health Care Strategies

Thursday, August 8th, 2019
 

The Brownsville Independent School District, like many public schools across Texas, is facing mounting, crippling health care costs through their self-funded health insurance program.

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Destroying Relationships

Wednesday, August 7th, 2019

“What do you do for a living?” asks the neighbor. “I destroy relationships” replies the salesman.

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Oh Oh, Novartis Hid Manipulated Data

Wednesday, August 7th, 2019

Approved in May, the treatment’s price — set at $2.1 million — stoked concerns about the astronomical costs of potential cures for rare diseases and upset parents who initially could not get insurance coverage for the breakthrough treatment.

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The Power of Labor Unions In Addressing Health Care

Monday, August 5th, 2019

Once labor unions learn the truth about what’s driving health care costs and become aware of proven methods to reduce costs while improving benefits at the same time, they will become a powerful force for change.  

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Million Dollar Mike

Monday, August 5th, 2019

He makes millions, threatens to deprive teachers, state employees, retirees and their families of affordable health care coverage.

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Profiting From The Poor

Sunday, August 4th, 2019

The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor

Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years.

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Innovative Defined Contribution Plan

Sunday, August 4th, 2019

Innovative Defined Contribution plan now available for groups of up to 99 employee lives. This could be a value add to small group health plans such as those available through Allied National (www.Alliednational.com) and others.

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HEALTH FUND REFUSING TO PAY FOR LIFE-SAVING DRUG

Sunday, August 4th, 2019

There is only one known cure for the disease……… however the drug, priced at $2.1 million, is too expensive and not covered by health fund……toddler has only one more month to receive a new drug that could cure him………………

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New Drug Costs $2.1 Million – A Plan Sponsor’s “Poison Pill”

Sunday, August 4th, 2019

“Specialty drugs account for about 1% of prescriptions but 95% of prescription costs.” A new drug approved this year will bankrupt health plans……………..Plan sponsors should carefully study their Rx formularies to determine if there are other “Poison Pills” lurking…….then take action.

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Tooth Fairy To File Bankruptcy?

Friday, August 2nd, 2019

Seven year old boy files Tooth Fairy claim…………….No-limit tooth provision to set record reimbursement rate……….Tooth Fairy spokesman hints at bankruptcy….. 

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Trump Administration, In Shift, Announces Plan To Permit Drug Importation

Friday, August 2nd, 2019

“These manufacturers would be able to use a new National Drug Code (NDC) in doing so, possibly enabling them to offer lower prices than are available under their existing distribution contracts…………………….”

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