Search Results for: favored nations

“The law just enacted by Michigan addresses the department’s concerns by eliminating MFNs and ensuring that Michigan consumers will benefit from enhanced health insurance competition,” Bill Baer, assistant Attorney General in charge of the Department of Justice’s Antitrust Division, said in an announcement. We’re pleased that the Michigan legislature and insurance commissioner agree with our … Continue reading Michigan Bans Most Favored Nations Contracts – Aetna Pursues Lawsuit

……. Blue Cross must notify the Justice Department and the state of Montana before it uses exclusive contracts with brokers, or exclusive or most-favored-nation provisions in its agreements with health care providers.  

  A federal judge has denied a request from Blue Cross Blue Shield of Michigan to dismiss a suit filed by federal and state governments, alleging the payor’s use of certain hospital contracts stifles competition, according to a Detroit News report. In a court hearing, U.S. District Judge Denise Page Hood said she would produce … Continue reading Judge Allows Lawsuit To Continue – Blue Cross’s Favored Nations Contracts At Issue

Bill, I read Lisa’s article  (See Post below) and she did a good job on the major points.   I enjoy the blog. By the way, The Michigan BCBS which was sued for “anticompetitive” behavior is one of the most outrageous suits I have seen.  This is how commerce works all over the world. If you  … Continue reading Dr. Alan Preston Offers Cogent Perspective on Favored Nations Contracts

The lawsuit, filed by businesses and residents of  Mooresville, was the first of more than 20 class actions making similar  allegations against Blue Cross plans nationwide.  Those cases have recently  been consolidated before a federal judge in Alabama, which means that the  litigation’s outcome likely would affect companies and policyholders  nationwide.

Michigan’s insurance commissioner has issued an order that insurers can’t put  certain restrictions in their hospital contracts without his approval. In an order dated Wednesday, Insurance Commissioner R. Kevin Clinton said he  is giving insurers six months to get approval for existing or future hospital  contract requirements. Starting on Feb. 1, Clinton will prohibit the … Continue reading Most Favored Nation Clauses Restricted By Michigan Insurance Commissioner

Blue Cross is accused of price fixing in a lawsuit filed last year. Could it be that Blue Cross agreed to hospital pricing demands, with the understanding that the hospitals would charge other PPO’s more? Did the negotiating process look something like this “Ok, we will pay you those high whorehouse prices you demand, but … Continue reading Blue Cross Accused of Price Fixing – Favored Nation Clause

The original RFP document said the state wanted bidders to show they could keep reimbursement levels below the current mark of 245% of Medicare rates, and as close as possible to 195%.

Blue Cross of Montana throws in the towel and joins the Reference Based Pricing movement at the expense of their provider partners…………………

Mike Dendy Eliminating the PPO domination of healthcare financing will represent a paradigm shift but one that is long overdue.

Mike Dendy, MBA, MHA “OPEC laughed at the US and the rest of the world when we complained that $120 per barrel oil was choking the life out of business and the public in general around the world.  Rather, they built ski mountains in their deserts out of the rest of the world’s money and … Continue reading The OPEC OF Healthcare

Peeling Back The Onion “Testimony submitted to the Council revealed that drug pricing methodologies and PBM compensation are complex and evolving, including rebates, price spreads, discounts, and other payments from retail pharmacy chains and manufacturers.” “Substantial evidence was submitted to the Council from ERISA plan sponsors and others that many PBMs do not fully disclose … Continue reading PBMs Should be Required to Disclose Fees and Compensation

“…This has led to the significant movement to eliminate PPO arrangements altogether as they not only provide no real value to the healthcare equation but in many cases promote a negative value…….”

“…..all elements within a market that do not add value to the overall market will eventually be eliminated……………….companies must work constantly to eliminate any cost factor that does not add value to a business process. ”

The U.S. Justice Department is widening an investigation into alleged collusion and price-fixing between Blue Cross BlueShield health plans and hospitals in several states, the Wall Street Journal reports. The investigation is focusing on whether certain Blues plans have struck “most-favored nations” deals with hospitals that would allow the increase of premiums while potentially locking … Continue reading Blue Cross Anti-Trust Probe Expands

         “Most hospitals will tell you that Medicare pays too little causing the hospital to lose money on Medicare patients.That is not true. The law requires Medicare to pay on average 1% more than cost at an efficient hospital. What Medicare pays should be a starting point in determining a reasonable charge for you. In … Continue reading Hospital Pricing Revealed – What Hospitals Do Not Want You To Know

      The Brownsville Independent School District is currently seeking competitive proposals for the administration of their self-funded health insurance program. PPO access and “discounts” will play an important role in the process of selecting a qualified vendor.

Molly Mulebriar, private investagator, weighs in on the BISD audit story: I have both the MedReview LLC audit done in 2007 and the CTI audit done this year. I dont agree with either one to the extent that I dont believe their methodology is bullet proof. Both based their findings off “discounts” and neither one … Continue reading BISD Audit – Molly Mulbriar Weighs In

The cost-plus method of paying hospital bills seems to make sense to many employers, with a growing number switching their plans from “secretly” negotiated PPO contracts to a fully transparent model. Cost savings achieved have been documented to be as high as 40% or more.  Bill Miller Forbes Cost based pricing makes sense for several reasons. First, the method … Continue reading Cost-Plus Hospital Reimbursement Catches On – Employers Embrace Concept

Freedom from high drug prices…………………………………..

With the stroke of his pen, Gov. Greg Abbott signed into law some of the strongest patient protection laws in the nation to shield Texans from the financial pain and misleading practices of free standing emergency rooms, where patients face a more than 80% risk of being balanced billed.

Brian Klepper “Renegade PCPs long for independent practices where their patient care decisions are not so influenced by their employers’ interests……………….By recapturing control of care and cost, they also are re-establishing primary care’s primacy within health care……………..”

….”Many Plan Sponsors view the lack of transparency within PPO contract(s) as a hindrance to Plan management.” …….”Respectfully, I would suggest that Mr. Page’s Memo is a step backward and an attempt to preserve a delivery model that was not effective in the past and won’t be in the future. ” – Steve Kelly CT … Continue reading Steve Kelly Responds To Ken Page

While all eyes focused on the presidential race, the ultimate fate of the Affordable Care Act (ACA) could depend on the Senate contests in the states.

(MILWAUKEE, WI) Published findings from a new report released today by the independent pharmacy benefit manager, Restat, found that employers could experience significant annual cost savings by adopting a “preferred” pharmacy benefit strategy. The report, “The Value of Alternative Pharmacy Networks and Pass-Through Pricing,” was researched and written by the internationally recognized consulting firm of … Continue reading Rx Preferred Network VS Go To Any Pharmacy Network