Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..

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Once upon a time there was no such thing as a PBM…………………….

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“Healthcare is the only expense line item in which all employees receive an unlimited budget…and also no training in how to spend it. That’s why they sign up for $2500 procedures when a $75 solution would do the trick.”  – Dave Chase

 “When the patient gets the bill, it looks like the insurer haggled on their behalf. Yet the final charge is still much higher than it should have been. The patient loses, while the insurer and provider win.” – Nikki Haley

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Trolling the internet on Chinese Flu quarantine day # 267 (and counting) we came across a website touting “Free Rx.” As we suspected, it was just another third party intermediary offering to assist consumers in applying for Rx manufacturer assistance programs. For a fee of course.

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Health Care:

We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.

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What are the statistics for TRS plan year 2020-2021? How many employees have moved over to heretofore illegal, competing commercial health plans and away from the state sponsored TRS ActiveCare government plan? What is the financial impact?

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Single payer system by 2028? Will Republicans embrace Obama Care as the better of two evils? Will whatever the Supreme Court decides have little effect on political realities?

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After talking with The Tyler (Grow Some Balls) Rose, Charlie was convinced he could achieve his goal of creating a better health plan — one his 150 employees deserved……………

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I’ve been hard at work on something I’m very proud of: a roadmap for communities, large and small, to restore hope, health and well-being.

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Beginning an initial dialog with “How much will you charge us” is never a good indication things will go well with your chances of gaining a new client as long as pricing is the driving consideration.

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RAND stokes hospital pricing transparency fire with new report

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Angie Stewart – Friday, January 10th, 2020

Eye and gastroenterology procedures are some of the most common services proliferated in ASCs, according to a March 2019 report by the Medicare Payment Advisory Commission.

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

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Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!

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The future of healthcare will be decided via the ballot box, court rooms, and congressional halls.

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Love Boat Cruise Spawns MGU……………………………

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Austin Startup Sana Benefits Raises $20.8M to Provides Self-funded Health Insurance to Small Businesses

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Austin-based health insurance startup Decent has raised $10 million as it looks to expand statewide.

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For Fairly, the real story – and challenge– is not about insurance markets; rather it is about risk management.

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With Bind, costs and choices are transparent and easy to compare. There is no deductible or coinsurance to meet before the plan starts contributing, and members can change and shape their coverage as their health needs change.

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If you had a group of employees traveling on a business trip and you told them they’d only need to pay a $100 contribution toward the hotel room, what’s to stop them from choosing a Ritz Carlton over a Days Inn? Both provide a decent night’s sleep, but one will cost you, the employer, a significant amount more.

This is what manufacturing firms are doing now with their benefit plans

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“Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.

“Holy Smoke guys, we’ve singled out our cheapest providers,  much cheaper than all the others,  20% cheaper! We call it the  I-35 Performance Network.” says the Aetna rep.

“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”

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“I Was Raised To Pay My Debts On Time…………..”

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GoodRx’s profitability is a rarity among start-ups filing to go public……………..

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When you go to fill a prescription, do you present your health insurance card at the pharmacy and assume you’re getting the lowest price? You may be paying too much. The cash price for many prescription drugs — especially generics — is often less than insurance co-pays.

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GoodRx, a digital health startup that helps users track prescription drug prices, filed for an IPO on Friday. The company hasn’t yet priced its shares, but plans to be listed on Nasdaq as “GDRX.”

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Allen is Only Expert Chosen to Represent the Insurance Industry…………

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TSHBP offers Texas school districts a TRS ActiveCare alternative for 2020-2021 school year. A careful review of benefits and rating structures indicates smart risk management strategies to control health care costs for members.

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Drug prices keep going up, and up, and up with no end in sight. Isn’t it about time plan sponsors get away from open formularies and change the way they purchase drugs? Or do plan sponsors want to continue to spend and spend and spend,  more and more?

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Psst…GodFather, Carl’s At It Again!

We just received word that Florida Schuessler Stick (The Schuessler Stick™) sales have recently spiked straining manufacturing capacity at plants world wide. So staff set out to find out why. The following is their report…………….

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Common sense dictates that medical caregivers who accept Medicare pricing should have no problem accepting Reference Based Pricing plans that uses the same pricing.

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ANGRY HOSPITAL ADMINISTRATOR REACTS TO THE NEWS……………

“The goal of the rule is to reduce a disparity in Medicare payments where hospital-affiliated clinics get paid more than physician offices for the same services. Some critics have said the gap has helped fuel a race towards hospital-physician consolidation.”

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• Cash Pay Community Provider Network includes PCP office visits, Specialist Visits, Radiology, etc. Zero balance billing issues – Providers paid in full through electronic fund transfer at POS
• Centers of Excellence for Surgical Procedures. Zero balance billing issues
• Reference Based Pricing for all other services. Plan will attempt to resolve balance billing issues however there is no guarantee those efforts will always be successful

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Micro-Dot Image of Heretofore Secret Health Care Strategium 

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Court records allege Cigna uses four distinct schemes to embezzle and convert funds by defrauding patients, healthcare providers, and their own Self-Insured Health Plan clients …………………

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So guys, this is what my typical day looks like now………………………….

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“What medical school did Zuckerberg go to?”……………………………….

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Why price of Humira keeps rising despite FDA approval of generic competition

“Patent thicketing, and Humira is the poster child for this, builds a patent fortress around their product to protect their ability to continue their monopoly pricing.’’

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Here are some highlights from the podcast:

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ARTICLE REFERRED BY: Charles Luke

7/29 TDI Releases Preliminary Report on Balance Billing Dispute Changes 

The Texas Department of Insurance has released a preliminary report on the effects of recent balance billing dispute resolution procedures passed during the 86th Session in Senate Bill 1264. In the report, TDI examined 9,000 requests over the first six months of SB 1264 implementation.

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We know a thing or two when it comes to employee benefits. Actually we’re what you might call an “industry leader” in all aspects of online employee benefits communication, education, enrollment and administration.

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The Purple Cow is down in Raymondville, Texas, lonely as hell………………

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Whether you own a company it, run it, invest or influence it- WellNet refuses to play by the rules of the ‘health insurance company cartels’ that seem to only be interested in protecting their revenue streams.

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Hospitals are becoming increasingly proactive in updating their Charge Master’s and doing so on more than a quarterly or annual basis yet Hospitals Dismiss Significance Of Chargemaster Prices?

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Gerard, our in-house prognosticator who is never wrong announced this morning that the dreaded Chinese Flu (The Pandemic) chaos will end abruptly on November 4, 2020. That’s good news for exhausted Americans.

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At the stroke of midnight, August 31, 2020 as much as 5% of TRS ActiveCare membership may vanish……………

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There is a frenzy of activity among insurance brokers, consultants, third party administrators and others towards seizing what is perceived to be a new found opportunity in selling lucrative group medical plan alternatives to the TRS ActiveCare program.

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Texas school district to over TRS ActiveCare alternative health plan effective September 1, 2020

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First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools……………….

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TAKE COMMAND HEALTH touts cost saving alternative to TRS ActiveCare………………

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Mike, in a recent post, you said you’ve been to Tennessee and Georgia, giving speeches and filming for your new show. Before that, you were on the road shooting for Dirty Jobs. Is it really so important to film a television show in the midst of pandemic? Is it responsible of you to encourage this kind of behavior when infection rates are spiking? Don’t you watch the news? More and more cases every day – aren’t you concerned? – Darlene Gabon

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Reference Based Pricing vendors rejoiced when a jury sided with a patient over an egregious hospital bill (Jury-sides-with-patient-in-hospital-bill-lawsuit/) But plaintiff’s attorneys were singing It Ain’t Over Til It’s Over………..

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SOURCE: Greg Rudisill on Linkedin

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Fred Rusteberg wasn’t interested in the limelight, but he was always there to help the people of Brownsville, his beloved hometown, and he left an indelible mark in the process.

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A couple of weeks ago I was interviewed by someone in the U.K. for a podcast called The Jist. I spent about an hour trying to explain our crazy healthcare system to someone who’s had no firsthand experience with any of it. As you can imagine, most of what I told him sounded quite insane to him.

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What exactly is being peddled here?

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Will Texas finally do something to fix health care for state employees and Texas educators? Fighting a $4.6 billion budget deficit can start with injecting common sense, reason and logic into how Texas funds health care………………….Or Is Texas still searching for their missing cajones? Hint: The little lady in Montana has them…………….

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Josh Butler is a West Texan who knows how to fix health care…………

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Shortly after posting the blog entry immediately preceding this post entry we received the following email message from Express Scripts:

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“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Mr. Yost said. “I intend to shed light on their business model………”

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“We knew that this was a time bomb because the percentage of obesity, hypertension, diabetes is so high,” said Dr. Adolfo Kaplan, a critical care physician who works with Dr. Brown at DHR Health in Edinburg, Texas. “

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Patient Centered Health Care vs Conveyor Belt Health Care

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UnitedHealth Group was the first major payer to release it second quarter earnings report, offering insight into how the coronavirus pandemic impacted the payer industry following the first quarter surge.

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“UnitedHealth Group treats all of the plans it administers as one huge piggybank, moving money around as it sees fit……………….”

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It was his dream job. He never thought he’d be bribing doctors and wearing a wire for the feds.

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Rather than basing Rx pricing by applying a discount off arbitrary sticker prices the strategy is to base pricing off what retail pharmacies pay for drugs. For example, if a pharmacy pays $10 for Drug A, the plan sponsor pays $10 plus a margin. This is Reference Based Pricing for Rx claims. But according to the following article this strategy does not save money. The American Rx pricing mystery continues…………….

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