The Rise Of The American Health Care Industrial Complex

March 9th, 2018

The American health care system has become one giant health care industrial complex………….

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March 7th, 2018
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“All advisors must endeavor to systematize their practices as much as possible so that they can remain competitive, highly profitable, and be in a position to grow in a disruptive and fee sensitive environment.”

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Trump Administration Warns Hospital Executive “Change is Coming”

March 7th, 2018

President Trump’s new health secretary issued a warning Monday to a room of hospital executives about soaring health care costs: change is coming, whether you like it or not.

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Is “Free” Cafeteria Plan Administration In Exchange For Products Legal?

March 6th, 2018

 

Many purveyors of voluntary employee benefits offer “free” Cafeteria Plan administration in return for the opportunity to sell voluntary products such as cancer plans. A portion of the commissions earned by writing agents are shared with the Cafeteria Plan administrator thus affording “free” administration services to the plan sponsor.

Is this practice legal?

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Free Market Medical – March Meeting, Austin, Texas

March 5th, 2018

FREE MARKET MEDICAL ASSOCIATION, AUSTIN CHAPTER – MARCH MEETING

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RxResults

March 5th, 2018

RxResults offers a multipronged approach to eliminate wasteful pharmacy plan spending on behalf of the employer and employee……………

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March 5th, 2018

This is your opportunity to speak with some of the nation’s leading experts as they outline new solutions to the current market………………..

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Taking The Mystery Out Of Shopping For Health Care

March 5th, 2018

“People should know what things cost in health care,” said Jeanne Pinder, founder and CEO of ClearHealthCosts. “We’re here to help.”

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Mulebriar Publishes Redacted DPC Agreement

March 4th, 2018

The Mulebriar organization has just released a redacted copy of a Direct Primary Care contract (DPC) of an organization that recently touted on social media they were the largest DPC provider in the United States.

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Reference Based Rx Pricing

March 3rd, 2018

Many plans are adopting Reference Based Pricing for their medical coverage. They can do the same for their Rx coverage.

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Patient’s Tattoo Prompts Confusion & Ethical Concern

March 2nd, 2018

Hospital staff to honor the patient’s DNR tattoo……………………

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Are you the Fiduciary or Co-Fiduciary for RBR balance billing claims? Why?

February 28th, 2018

 Mike Reagan

Fiduciary risks are major concerns for most employers and their advisors, especially when the employer’s healthcare plan is self-funded……………

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Whistleblower Claims BCBS Scammed Taxpayers Out of $1 Billion

February 28th, 2018

After some digging with the help of attorney Steve Cohen she discovered the insurer “deliberately exaggerated the benefits available under the plan, while understating the uncovered costs that must be paid by members……………..”

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Toro Totter

February 27th, 2018
 Moma, will our insurance cover accidents?

Will Government Price Controls Fix Health Care?

February 27th, 2018

Medicare Extra is a Reference Based Pricing program that mandates government price controls.

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AHA, Maybe This Will Work!

February 27th, 2018

20 States Sue Government Claiming Repeal Of Individual Mandate’s Tax Penalty Renders Law Unconstitutional

The states also say in the suit that because the health law doesn’t have a “severability clause” — a provision that says if one part of the law is struck by the courts, the rest would stand — if one part of it is struck down, the rest is invalid.

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Ordering Pizza? Let’s Check Your Medical Records First

February 27th, 2018

May I suggest that this time you order a pizza with ricotta, arugula, sun-dried tomatoes and olives on a whole wheat gluten-free thin crust?

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How To Become Independently Wealthy In The Urine Business by I.P. Freely

February 24th, 2018

Patient blindsided by $17,850 urine test that insurer said was worth $100………………….

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Are Non-Disclosure Agreements For Dishonest People?

February 24th, 2018

Does one’s refusal to sign a non disclosure agreement indicate a sign of dishonesty? Or does it indicate something else?

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Are The BUCA’s Invested In Higher Medical Costs?

February 24th, 2018

Here’s a simple calculation of the stock price growth of major health plans – United, Aetna, CIGNA, Humana and Anthem – over a period of just less than 9 years since the passage of the Affordable Care Act. Stock price has grown a breathtaking 5.3x-9.6x, about 3x the growth of the Dow Jones Index and 2.5x the growth of the S&P over this period.

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Medicare Extra – The Ultimate Reference Based Pricing Plan?

February 23rd, 2018

The cost of coverage would be offset significantly by reducing health care costs. The payment rates for medical providers would reference current Medicare rates—and importantly, employer plans would be able to take advantage of these savings.

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Derek Rine

February 23rd, 2018

“Derek understands that taking control of the healthcare spend has to start in the C-suite”

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Region One Education Service Center Seeking Competitive Proposals

February 22nd, 2018

Region One Education Services Center is seeking competitive proposals for voluntary employee benefits as well as certain employer paid benefits.

RFP 19-AGENCY-000042 is now available. Region One ESC and its Cooperatives have a new online procurement system e-BuyOne! Click here and register today! à www.esc1.net/eBuyOne

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Fiduciaries

February 22nd, 2018

“It is amazing that almost 44 years after ERISA became law that an An Alliance Bernstein (AB) LP (AB) survey asked 1,000 DC executives if they were fiduciaries: 49% said no, and 6% didn’t know. Based on their duties, all were fiduciaries. Even 48% of the executives from plans with assets of $500 million or more thought they were not fiduciaries. Are your Health plan fiduciaries aware?” – Vincent Flores

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Healthcare Disruptor Declares War Is Won Despite More Battles Ahead

February 22nd, 2018

“Is it any wonder that when you tell an employer they can return 30% of their number two business expense to the bottom line, stabilize future cost and make their employees raving fans of their healthcare funding plan, they would like to see proof? ” – Tommy Taylor

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Changing The Paradigm For Texas Public Employers

February 21st, 2018
 
Texas political subdivisions are struggling to address rising medical costs which, in most cases, represents their second largest budgetary expense after wages. Seeking economies of scale, some counties, cities and school districts have joined risk pools such as TML, TAC and TRS ActiveCare. However, the concept of the power of large numbers has failed to control costs.
We know why……………………………………………

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PPO “Discounts” Are The Things of The Past

February 21st, 2018

 

 

This is how the fraud is committed, and this information is not provided in any reports provided by the hospital or insurance company so the hospital commits the fraud and the systems in place (Artificial Intelligence or lack thereof) is how the claims get through without touching a human hand……………….

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Texas Insurance Agent Hits It Big On Shark Tank

February 20th, 2018

An Amarillo Farmers Agent, Scott Houdashell and his friend Curtis McGill hit it big on the Shark Tank this week receiving multiple offers to invest in their multi-million dollar eggmazing business which began with an electric screw driver, hot glue stick and a spoon……………………

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Attention Plan Members: Sue Your Employer For Breach of Fiduciary Duties

February 19th, 2018

Lawyers standing by…………………………….

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Health Care Strategies for Political Subdivisions

February 18th, 2018

An entire strategy for solving health care is centered upon the power of knowledge squarely based on reason and logic against which status quo special interests cannot prevail…………...

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States Want To Import Canadian Drugs

February 18th, 2018

“We recently repriced the top five highest drugs utilized by a client. We simply entered the data on a site we found on the internet for retail Canadian drug prices. The pricing differential was a whopping 80% ” – Bill Rusteberg

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It’s The Price Stupid!

February 18th, 2018
Health care costs are going up because providers are charging more and we collectively agree to pay these increases. This article proves the point…………………………….
“The only way to pay less for health care is to pay less for health care.” – Author/s Unknown

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TV Station Buys $1 Million Worth of Medical Debt for $12,000

February 17th, 2018

When healthcare providers are unable to collect payment on medical bills, they sometimes sell the debt to collection agencies, often for as little 1 cent for each dollar owed.

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Carl Schussler

February 17th, 2018

An intentionally small “concierge” consulting firm offering a unique approach to benefits management to a select group of clients, Benefit Strategies provides Insurance, Risk Management and Employee Benefits Consulting.

Serving as a Population Health Manager specializing in Cost Containment and Risk Mitigation, the partners pride themselves on their ability to be creative in designing innovative, optimum plans and helping companies and individuals make the most of their financial resources by serving as a Fiduciary and Steward of health plan dollars. With more than 25 years of experience in employee and executive benefits consulting and financial planning experience, Carl offers clients improved cash flow, saves money and retains top talent with well-structured employee benefit and financial planning solutions. He is also an accomplished speaker and author.

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United States Government Can Sue UnitedHealth Group in $1 Billion Medicare Case

February 15th, 2018

 “Will my premiums increase?”

(Reuters) — A federal judge has ruled the U.S. Justice Department can move forward with a lawsuit claiming UnitedHealth Group Inc. wrongly retained more than $1 billion from the government health care program Medicare.

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A Tale of Two States

February 15th, 2018

What a difference 290 miles can make in how one State Governor’s administration and legislature can view health care rights of a population. Is health care a right?

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Vindication!

February 14th, 2018

In a major victory for ERISA plans and other payors, the Fifth Circuit recently overturned a district court’s notorious decision in favor of a healthcare provider and reinstated a plan administrator’s ability to guard against healthcare billing fraud, waste, and abuse.

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Businesses Challenge IRS Bid to Start Enforcing Insurance Mandate

February 14th, 2018

Under Affordable Care Act, companies with more than 50 employees must offer health insurance. Now some getting hit with penalties are disputing the fines………………………….

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February 13th, 2018

Texas political subdivisions are struggling to address rising medical costs which, in most cases, represents their second largest budgetary expense after wages. Seeking economies of scale, some counties, cities and school districts have joined risk pools such as TML, TAC and TRS ActiveCare. However the concept of the power of large numbers has failed to control costs.

We know why………………………………………….
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Recording Phone Calls Makes Your E&O Provider Happy

February 13th, 2018

Accountability is so important in Business today, All agents selling over the phone should be recording the sale for their protection and ours. With InsurAlign record all your sales calls easily and at a very low monthly cost. GAC affiliated with Agents receive a discount. Watch the YouTube video and see how the system works.  

  • Unlimited Calls
  • No limit on Call Duration
  • Required recording disclosure announced to the client
  • Upload your recordings to Dropbox or Google Drive
  • Label recordings so you can easily find them
  • recordings available as soon as you hang up
  • recordings emailed to you

Plans Start at $29.95 per month, $24.95 for GAC Agents. Use Coupon Code – GACAGENTS To Save $5.00 per month. Join Today! You’re Going to Love It!!

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Understanding How Carriers Calculate Renewals

February 12th, 2018

Insurance carriers typically start with a high quote to provide room for negotiation……………….

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The Rise of Reference Based Pricing

February 12th, 2018

“There’s one trend driving the CVS/Aetna merger that the industry isn’t talking about: referenced-based pricing.

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Value Based Health Care

February 12th, 2018

The Experience To Drive Change

The transition to value-based care is accelerating. Evolent Health partners with provider organizations who are leading the change within their communities, providing the infrastructure and financial support providers need to achieve clinical and financial success.

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Health Care Miranda Rights

February 12th, 2018

 

During a recent renewal meeting an employer asked if (BUCA) would object if they hired an outside audit firm to review claims. Before the rep. could answer I jumped in and read the BUCA rep. the HealthCare Miranda Rights :

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School District Adopts Cost Saving Strategies – Reduces Cost 25%

February 11th, 2018

When Peoria Public Schools began working with AIMM the medical cost PMPM was close to $500 dollars. The group was eager to avoid cost-shifting and benefit erosion………………..Within three years, the medical cost PMPM have decreased by 25%.

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Why Do Americans Act Against Their Own Economic Interests?

February 11th, 2018

. “Americans act in ignorance of, and thus against, their own economic interest, making health care inexcusably expensive…..”.

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To The Rescue – SpreemoHealth

February 10th, 2018

Finding the right doctor at the right time, the right place, and at the right price is not something consumers are prepared to do. SprrmoHealth provides the solution………………….

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Reference Based Pricing Alone Is Not Enough – THE MISSING PIECE

February 10th, 2018

 

Away from the noise in Washington, there’s a quiet movement to improve healthcare and lower costs—and it’s making progress. The movement is led by employers and other large purchasers of health benefits, like unions and retirement plans, which cover the majority of Americans. Starting with this post, I will periodically profile the pros and cons, as well as some of the more influential and promising strategies used by these purchasers. Today I will focus on a strategy called “reference pricing.”

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4 Steps To Implementing Reference Based Pricing

February 9th, 2018

advancedpricing.com/wp-content/uploads/BenefitsPro_RBRarticle.pdf

This Job Could Save America

February 9th, 2018

There is one job that plays a central role to fixing the healthcare mess: the benefits consultant. No one has a bigger influence over health purchasing than benefits advisors.

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Amazon Warehouses Stocked With 20,000 Doctors In Preparation For Healthcare Launch

February 6th, 2018

Saying the online retailer was attempting to get ahead of the anticipated rush, Amazon CEO Jeff Bezos announced Wednesday that his company’s warehouses have been stocked with 20,000 doctors in preparation for the launch of his new healthcare initiative.

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Media Coverage of Amazon/Berkshire/JPMorgan Misses the Point.

February 3rd, 2018

 

The coverage of the JPMorgan/Amazon/Berkshire Hathaway healthcare initiative has been universal, breathless, and mostly superficial.

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Measuring Plan Performance

February 3rd, 2018

Our group medical plan is doing much better this year than last year! Really, how do you know?

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Pharmacists: New Reimbursement Rates for Drugs Unsustainable

February 3rd, 2018

Working the Spread“He also recounted an extreme case in which a pharmacist lost more than $100 on a psychiatric drug for which he was reimbursed $431. Meanwhile, the patient’s explanation of benefits from Arkansas Blue Cross indicated that his insurance had paid $1,005 for the drug, leaving a “spread” of $574 that was presumably retained by Caremark/CVS.”

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American Healthcare Revolution – The Militia Has Formed

February 3rd, 2018

“You can always count on Americans to do the right thing – after they’ve tried everything else.” – Winston Churchill

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February 2nd, 2018

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“If interested I had a very insightful interview with Dr. David Nash yesterday on PopHealth Week.  For those who don’t know David, he is the Founding Dean of the College of Population Health at Jefferson, an Internist and on the Humana Board.  I have never heard him so negative, he stated PCMH doesn’t work, ACOs don’t work, and finally just said doctors need to look in the mirror, there are too many mistakes and deaths, too many tests ordered etc.  Very interesting 30 minutes if you have time.” – Frederic Goldstein

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Are Fully Insured Health Insurance Programs Obsolete?

February 2nd, 2018

The old world died a few years ago, so it’s time to quit thinking in the same terms as you did before…………

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A Whiff of Market-Based Health Care Change

February 2nd, 2018

“There are proven but mostly untapped approaches in the market that effectively manage health care clinical, financial and administrative risk, consistently delivering better health outcomes at significantly lower cost. In the main, legacy health care organizations have ignored these solutions, because efficiencies would compromise their financial positions.”

Brian Klepper

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Benefits Question

February 1st, 2018

 

I have a very complicated benefits question. Many years ago, I married a widow who had an 18 year old daughter. After the wedding, my father, a widower, came to visit a number of times, and he fell in love with my step daughter. My father eventually married her without my authorization.

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Michael Ryder Receives Letter Granting Unemployment Benefits

February 1st, 2018

 

SAUGATUCK, Mich. — Michael Ryder had been approved for $360 every week in Michigan unemployment benefits — until the state learned he’d been dogging it at the Detroit-area restaurant chain where he supposedly worked.

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Salt Water Anyone?

January 31st, 2018

In Just 2 Hours Amazon Erased $30 Billion in Market Value

January 31st, 2018

The market value of 10 large, listed health insurance and pharmacy stocks 1 dropped by a combined $30 billion in the first two hours of trading.

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Pre-Order Your Organ Transplant Here – Customized Selection Process Individually Taylored

January 31st, 2018

How Two Common Medications Became One $455 Million Specialty Pill

January 30th, 2018

The drug has been controversial, to say the least. Vimovo was created using two readily and cheaply available generic, or over-the-counter, medicines: naproxen, also known by the brand Aleve, and esomeprazole magnesium, also known as Nexium. The Aleve handles your pain and the Nexium helps with the upset stomach that’s sometimes caused by the pain reliever. The key selling point of this new “convenience drug”? It’s easier to take one pill than two.

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Amazon, Berkshire Hathaway, JPMorgan Chase To Tackle Health Care

January 30th, 2018

 

Growing health care costs “act as a hungry tapeworm on the American economy,” said Berkshire Hathaway CEO and chairman Warren Buffett in a statement. “Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country’s best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes.”

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Tell It Like It Is…………………

January 29th, 2018

When anyone tells us about manufacturer Rx rebates, our response is “Oh, you mean commissions, right? That’s what this is all about…………commissions. Commissions on a $100,000 per year specialty drug can be $45,000. Opps, I meant the rebate could be as high as $45,000.

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Solving Health Care: “It’s The Price Stupid”

January 29th, 2018



This article substantiates what we have been saying – health care costs have remained essentially flat but health insurance costs have not. Providers are simply raising their prices (not their costs) through secretive managed care contracts (PPO) you are not allowed to see nor audit.

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The Medicaid Scam: Higher Taxes Are an “Investment” to Generate More Spending

January 28th, 2018
 

don’t like it when voters support tax increases.

Needless to say, voters rarely if ever vote to raise their own taxes. Instead, they get seduced into robbing their neighbors in exchange for the promise of new goodies from politicians.

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Kicking The Can Down The Road & Believing in Magic

January 27th, 2018

Large self-funded employer sponsored health plan adopts ill informed strategies to reign in health care costs……………

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Call For Cash Pay Providers – Houston Market

January 27th, 2018

We are have a few more openings on our panel for surgeons and proceduralists in the greater Houston area who offer affordable cash pay procedures or have an interest in beginning to offer these. We are providing the infrastructure and the willing consumers, seeking a few more willing providers! Message me, please if interested.

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Hub International Caught Up in $42M Lawsuit by South Carolina School District

January 27th, 2018

A South Carolina school district has sued an insurance brokerage and several insurance companies, saying the district was sold excessive policies and charged too much.

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5 Days Guaranteed!

January 23rd, 2018

Some medical-claims reduction companies wait until the last minute to resolve your claims – sometimes waiting too long and leaving you and your clients with a bigger bill than necessary.

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Working The Spread

January 23rd, 2018

The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.

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Balance Billing Is A Plan Sponsor’s Best Friend

January 22nd, 2018

jet

“Balance billing only occurs when purchasing  goods or services without asking  the price.”

 

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Be Wary of Your Insurance Broker

January 21st, 2018

The insurance industry is an anomaly. How so? It plots to eliminate competition and limit the flow of information in order to maximize income, all at customers’ expense………………

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