“Knee replacement? That’s $18,000, tip included. You will find it under “House Specialties” here” said the waitress. “OK Great! I’ll take two of those” says the customer. “And hook me up with a slow drip Miller Lite.”
“I’ll take the bursectomy” says his wife as she elbows her husband with a playful grin. “Does it come with an after dinner sling or is that extra? And I’ll take an Epidural Martini, shaken not stirred.“
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November 30, 2022
The Texas Mutual board of directors approved the initial steps for creating a health coverage-focused subsidiary. Last year the Texas Legislature authorized Texas Mutual to potentially offer health coverage solutions through a subsidiary that could help the people of Texas and Texas businesses.
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“Surprisingly, when asked about healthcare experiences, 76% said they have had a positive patient experience in the past three months and 60% said they have had a negative experience.”
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This is where the small group health insurance market is going – rapid simplified underwriting. In the not too distant future we believe brokers will have the ability to field rate firm quotes in minutes.
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The Lisa Plan, an employer funded cash driven health plan strategy, is considering a partnership with Lionel to provide timid brokers and plan sponsors with sleep insurance designed to allay fears of the unknown. No longer will Lisa Plan members wonder and worry if their plan will be accepted by medical caregivers.
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This is old news but relevant in today’s age of cell phones and instant messaging………
“Carver Dan Peavy (Peavy) was elected a trustee for the Dallas Independent School District (DISD) in 1986, so serving until 1995. By the early 1990s, he controlled purchases of insurance for DISD employees. He was a friend and business associate of Eugene Oliver, an insurance agent who had been convicted as an accomplice to murder” (PEAVY v. WFAA TV INC ).
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“The Biden administration announced Tuesday that it’s seeing a big uptick in the number of new customers buying private health insurance for 2023 from the Affordable Care Act’s marketplace. The boost in enrollment is largely driven by generous subsidies—extended through 2025 in the Democrats’ $1.9 trillion coronavirus relief law—that keep monthly premiums payments at $0 or just a few dollars monthly for most people who sign up.“
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Operating worldwide, Insurance Supermarket International Inc. operates through a network of offices including Toronto, Canada; Miami, U.S.A.; and Brasov, Romania, with a team of over 700 globally….
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by Daisy Wolf and Vijay Pande
We think the biggest company in the world will be a consumer health tech company.
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Doug Aldeen• ERISA Healthcare Attorney and General Counsel
“WTF” can best be summarized as follows:
A) William “The Fridge” Perry lining up as a fullback (all 338 lbs) for the 1985 Chicago Bears;
B) A number of not for profit hospitals charging 13% interest on a “credit card” for outstanding medical bills for individuals that are already functionally uninsured and now deeper in debt;
C) Marilyn Monroe/JFK/Lee Harvey Oswald/ all killed within 13 months of each other;
D) A NYC investment bank charging recently released felons $30 transaction fee’s on a $500 debit card (true story);
E) All of the above.
Easy Access Health Insurance In Minutes………………..
Our new and improved online quoting system is now live! You can now get instant quotes and rates, without ever leaving your desk. So, if you’re looking to find a new health insurance company, or just want to find out what you qualify for, you can do it right now! Get started by clicking below – Isaac Higgins
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Why would any plan sponsor that’s able to pay cash at the point of service reimburse a hospital more than their discounted cash price?
The time value of money in a typical claim cycle averages 90 days X cost of money. What is 90 days worth in the value of services received in today’s dollars? Suppose a claim under a PPO contract is paid at 225% of Medicare and the cash price is 100% of Medicare, the time value of money under a PPO contract in this instance is 2.25. That beats money market and CD rates these days.
(more…)Plan sponsors have all sorts of risk transfer strategies from which to choose from. Stop loss insurance is an obvious risk transfer strategy. Then there is ACA mandated HFAP risk transfer and specialty drug risk transfer. How about transferring risk to Medicare? It’s the older folks who have more medical expense needs often driving up costs for a group plan.
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TotalRx.net is a valuable way to get access to network contracted rates, without worrying about deductibles or maximum benefit limits. With an unlimited formulary, and zero program rules, members are given a freedom seldom available to them in the benefit marketplace today.
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“There are plenty of Americans who are fine with what they are paying for insurance, including 67% who think their insurance premiums are fairly priced or inexpensive……..69% spend less than $500 per month on insurance…………….53% spend less than $250 per month“
And best of all, 60.6% of Americans pay no income taxes…………….life is good in America!
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Leadership Can Be Learned At Boon-Chapman. Boon-Chapman’s Program was designed for Two Types of Leaders: “People Leaders” and “Thought Leaders.”
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Walgreens plots ‘aggressive’ strategy to build out healthcare services, CEO Roz Brewer says
On the heels of several high-profile acquisitions, Walgreens aims to be a point of entry for consumers for healthcare services ranging from urgent care to specialty care and even in-home health.
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“Pam said she was told that if everyone paid the lower cash rates then there would not be any reason for people to use their health insurance.” SOURCE: Yes, You Can Pay Cash for Health Care.
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Drugmakers pushed aggressive diabetes therapy. Patients paid the price.
Pharmaceutical giants launched years-long marketing campaigns for a treatment target they helped create, and as their sales of diabetes drugs soared, so did incidents of low blood sugar, a potentially deadly medication risk.
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“The insurer may not base the reimbursement to the physician or provider on the insurer’s usual and customary rate; and shall reimburse the phnysician or provider at the physician’s or provider’s specialty rate in accordance with the physician’s or provider’s expertise, experience and rate history.”
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“It is the intent of the legislation that the premiums for TRS-Care and TRS ActiveCare be calculated and adjusted taking into consideration the money appropriated ($286,337,761) under this section.”
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Some make getting aid hard, delay checking eligibility and press for payments that aren’t refunded…….
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“This is going to be the solution that frees you from the dysfunctional medical system…….People have been led to believe that healthcare is so expensive that they can’t afford it without insurance… we teach you how to go without insurance and yet not be financially at risk. We call it assurance, vs. insurance.”
(more…)I was a 19-year-old machine gunner at the Battle of the Bulge in World War II. And I didn’t talk about my Army service for more than 65 years after that.
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Ed Snowden releases a new cache of emails purloined while working for the CIA. One explosive email exposes a sinister conspiracy to upend American commerce.
(more…)The next biennial Texas legislative session begins January 10, 2023 and it’s going to be a doozy, action packed with a significant number of bills to be introduced related to insurance matters.
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Johnny Dollar was every insurance executive’s dream, an investigator who found the bad guy, or girl, and kept the insurance company from paying out a bunch of money on a bogus claim. People offered him a cut of the money and women offered him even more but Johnny couldn’t be persuaded to throw away his integrity for a bribe.
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It takes hospitals months and months to get paid for services. It involves pre-certification, claims filing, handling claim disputes, chasing patient share and a whole lot of other nonsense. After reading the article below timing couldn’t be better to suggest to hospitals there is a better way.
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By David Contorno on Linkedin (Posted Saturday, 13 November 2022
Our 13 year old daughter, Hannah Contorno, who many of you met at our inaugural You Powered Synpoisum, was diagnosed with a rare blood disorder this week called Acute Immune thrombocytopenia (ITP).
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“Employer-purchasers need to let go of their “devil you know” mindset and stop buying into the narrative that employees can’t handle change. Although there may be risks in taking action, they are far less than the risks of comfortable inaction that have enabled a vast transfer of wealth from working Americans to the medical industrial complex.” – Neil Quinn
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By Bill Rusteberg
If you’re active in vying for public sector business we extend our deepest sympathies. It’s a tough world out there dealing with politicians and bureaucrats.
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Hospital spend equals 40% of a plan’s spend. Professional spend equals about 20%. That leaves 40% left over. Guess which beast feasts on the remaining 40%?
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Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.
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“We then compared that uninsured person to us – what we’re paying – and in many cases what we found is we’re paying more than an uninsured person.”
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“Full disclosure of direct and indirect compensation triggers the business equivalent of finding out one’s spouse cheated on them.”
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Employers Don’t Pay – You Do
Employers don’t pay a dime towards employee health insurance. Employees pay the full boat but don’t realize it. Try explaining that to the police and fireman union during the next negotiation cycle.
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A HSA is by far the best tax advantaged investment ever devised by mankind. Contributions are tax exempt. Withdrawals before age 65 for qualified medical expenses are tax exempt. Withdrawals at age 65 and used for any reason are tax exempt.
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You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?”
(This article first appeared on this blog March 7th, 2021. It was written at the suggestion of the President of a local County Medical Society representing over 4,000 physicians in Texas. His intention was to recommend it be published in their monthly newsletter. It never was.)
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Walgreens-backed VillageMD announces $8.9 billion deal
by Bloomberg 08 Nov 2022
by Michelle F. Davis
VillageMD, the primary-care provider controlled by Walgreens Boots Alliance Inc., has agreed to acquire Summit Health-CityMD in an $8.9 billion deal that shows the drugstore operator expand deeper into health-care services to reduce its reliance on retail.
(more…)New proposals for universal health care in Oregon and Washington
NOVEMBER 6, 2022
Once again, it’s time to consider universal health care. What are the implications? Could it happen?
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Status quo health care pricing through managed care contracts hasn’t worked out very well. Reference Based Pricing is an alternative, transitory strategy that has worked. But there is something better……….
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If Rx standalone Stop Loss premium = 2-3% of overall Rx spend and the savings on medical stop loss premium is 5%-10% when carving out the Rx program, what is the net difference?
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ReviveHealth and PCI Direct Care have partnered in a collaborative effort to bring a differentiated and competitive solution providing affordable and easy access to primary health care and prescription drugs for members located in the Lower Rio Grande Valley in deep South Texas.
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Insurance companies have traditionally required a minimum percentage of employees to enroll in coverage. Participation requirements helps insurance companies avoid adverse selection. Minimum participation requirements have traditionally been 75%.
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“The Medicare payment schedule released today puts Congress on notice that a nearly 4.5% across-the-board reduction in payment rates is an ominous reality unless lawmakers act before Jan. 1”
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The independent thought leaders at Catalyst for Payment Reform (CPR) have recognized Vitori Health as a Market-Shaping Enterprise (MSE) that’s helping to reshape the dysfunctional incentives that influence today’s healthcare market.
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By Bill Rusteberg
Five years ago a San Antonio plan sponsor had enough. Self-insured with a BUCA wasn’t working out too well. Three years in a row annual rate increase of 20% and more each year was unsustainable. Drug costs were going through the roof. Something had to be done.
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Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….
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“If you could pay $25,000 for a car or $75,000 and the only difference was the overhead of the dealership, why would you pay $75,000?”
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For the first time in more than a decade, your Medicare Part B payments will be going down in 2023.
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When the dust settles 18 months from now Blue Cross of Montana is gonna look like Superman to Montana legislators by saving millions of dollars on the state’s Reference Based Pricing employee health plan.
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Article Referred By Bob Calvisi
Kalsariya had no way of knowing then that she was embarking on a crusade that would take over a year, send their bill to debt collections, lead her to complain to the Illinois attorney general, and discover that the hospital charged nearly $7,000 for a procedure that was never performed.
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Blue Cross of Montana throws in the towel and joins the Reference Based Pricing movement at the expense of their provider partners…………………
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If TRS ActiveCare would adopt this strategy there would be no commercial vendor able to compete competitively. The only difference would be in fixed expenses which TRS ActiveCare would win hands down. Commercial vendors have enormous expenses TRS ActiveCare doesn’t.
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If you can’t beat them, join them. A stirring giant ends hibernation in Montana………….
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Price maker vs. price taker- Montana tweaks its RBR model
Doug Aldeen ERISA Healthcare Attorney and General Counsel
“…Montana is positioning itself to tweak its model, just as more states and employers, seeking to cut costs, consider adopting it. That has health economists and those working to lower hospital prices elsewhere wondering whether the state is once again moving ahead of the curve — or setting itself up for a setback.”
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Aldeen’s Sunday Morning Bathroom Read exposes BCBS Admin. Agreement with the State of Montana. BCBS was recently awarded a contract to administer the state’s Reference Based Pricing plan.
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Dr. Peter McCullough, one of the most respected doctors in the world, has been a beacon of light throughout this pandemic. His reward for speaking the truth? He’s being stripped of his credentials.
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These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus…..
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When it comes to solutions for the healthcare system, Americans are more divided. Younger Americans, those between 18 and 49, are more likely than adults older than 50 to believe it is the federal government’s responsibility to make sure all Americans have healthcare coverage. Overall, two-thirds of adults believe this, up from 57% in 2019 and 62% in 2017.
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According the the American Hospital Association, “Only employer-based plans regulated under ERISA may use reference-based pricing as a comprehensive payment strategy.“
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SOURCE: SOLVING THE HIGH COST OF HEALTHCARE WITH OTHER PEOPLE’S MONEY
The overarching goal of Obamacare was to expand access to health insurance, and to make it affordable.
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“We’re leaving TRS ActiveCare and you’re not welcome back for five years!” says Little Rabbit Independent School District.
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Employees facing unaffordable premiums and out-of-pocket burdens may decide to self-select out of group coverage in favor of individual policies, Medicaid (if eligible), or no coverage (uninsured).
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An attractive, low cost, capitated employer sponsored plan for $125 per employee per month covering primary care, ER visits, lab and radiology with no co-pays, deductibles with no restrictions on pre-existing conditions?
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