New Evidence-Based Healthcare Pricing Standard Available for Paying Out-of-Network Medical Claims

MyHealthGuide Source: Denniston Data Inc, The Healthcare Transparency Company, 4/10/2024

The U.S. healthcare marketplace needs a transparent standard that is fair to patients, providers, and self-insured employers offering health benefits to their employees.

AUSTIN, TX — In its Healthcare Pricing Guide (HPG) solution, Denniston Data Inc. (DDI) offers standardized benchmark rates by procedure code inclusive of all in-network negotiated rates for every medical service performed by every provider, from every health insurance company. These agreed-on negotiated marketplace rates can be used as the basis for fair compensation for out-of-network providers.

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RBP Pure Medicare Methodology Is Flawed

WellRithms Publishes White Paper Exposing Flaws in Reference-Based Pricing and Introduces Superior Alternative

“While RBP allows employers more than one way to pay a medical bill without having to establish a provider network, thereby opening the marketplace, it has still failed to provide a methodology that is transparent and understandable. RBP’s pure Medicare multiple is arbitrary and does not meet the definition of UCR pricing.”

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Stop Loss Carrier With Bells On Their Balls Offers Participating Contract

How do you know if your stop loss carrier has bells on their balls? And what’s the implication if they do or don’t? Glad you asked………..

We just learned of a stop loss carrier that guarantees, for a premium load of 6%, a 30% premium refund if spec. claims are below 50%.

Participating stop loss contracts are not new although few brokers and plan sponsors are aware they exist.

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Mike Keogh

“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

By Bill Rusteberg

Mike Keogh was an extraordinary man. A former Blue Cross salesman in the 1950’s, he later built an independent brokerage in San Antonio with great success. I met Mike in the early 80’s and did quite a bit of business with him.

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Another Government Health Insurance Ruling Issued Because You’re Stupid & Can’t Read

“We had to issue this new ruling because Americans can’t read!” explained the high ranking government official during Happy Hour at the Off The Record watering hole.

“But if that’s true, how do you expect them to read the new rule?” replied the bartender.

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The Great Escape

Health insurance has become a highly regulated government utility complete with punishing government sanctions for those who err. All make mistakes, for to err is human and pervasive. No one is perfect. An attorney’s dream.

A post on Linkedin yesterday reminded all of us how complex compliance issues are plaguing government enslaved employers these days.

Below are 15 reasons why ICHRAs make sense to more and more employers fed up with all the rules and regulations, ready to escape the threat of punishing government sanctions, contingency based lawsuits and time lost to productivity when dealing with the non-sensical and crazy world of American health insurance.

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The Erosion of Physician Autonomy

“He Who Controls Referrals Wins” – Molly Mulebriar

“Around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system…………..Many physicians say they are losing their ability to influence how patient care is delivered — 60% of physicians said non-physician ownership of practices results in a lower quality of patient care, according to the NORC survey.”

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Baltimore Bridge Losses Could Be A Record Shipping Insurance Loss

Insurers could face losses of up to $4 billion after Baltimore bridge tragedy-analyst

By Sinead Cruise, Jonathan Saul and Carolyn Cohn

LONDON (Reuters) -Baltimore’s Francis Scott Key Bridge collapse could cost insurers billions of dollars in claims, analysts say, with one putting it at as much as $4 billion, which would make the tragedy a record shipping insurance loss.

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The Texas School District Courtship Season Begins

TSHBP sent out invites last week to hear their sales pitch. Now TASB has sent out theirs. Who will be next?

TSHB has the more attractive offer – FREE FOOD and GIFT CARDS for attendees.

TRS ActiveCare is at a disadvantage since they are prohibited from competing for business for up to five years under certain circumstances.

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Walmart Learns Human Labor Can Be Cheaper Than Machine Labor

Walmart Self-Checkout Scheme Backfires – INFLATION ALERT: Business overhead expenses for Walmart shopper thieves goes up.

A self-checkout machine doesn’t earn a salary or hourly wage. These silent, non-complaining beasts don’t need expensive company provided health insurance or Workers Compensation. They don’t get paid time off either. The little Beasties, it was thought, were going to reduce payroll costs and increase profits for the retail giant.

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Mark Cuban Fires His Insurance Consultant

“He first turned to the employee benefits consultant who had assured him he was getting a great deal—someone whose advice also cost $30 per employee per month.”

“That’s insane, that was millions of dollars,” Cuban says. “The person who put me into a program where I was paying eight times more than I should have for generic medication, they’re done.”

Around the time he dropped the consultant, Cuban was planning to get a CT colonoscopy, which he says would’ve cost more than $2,000 through insurance. Yet the walk-in cost for the same procedure was less than $500.

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Call Armando For Price Check On Specialty Drugs

Want to save $40,000 on a plan member taking an expensive specialty drug during the course of your plan year? Same manufacturer, same dosage. same packaging. We were able to do exactly that for a Texas county government health plan thanks to Armando. We turn to Armando when we need help sourcing expensive specialty drugs” – Bill Rusteberg

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Which Blue Cross Plan Has The Most Members? The Answer Will Surprise You

Largest Health Insurance Companies 2024

Chris Kissell

While some of these large health insurance companies are household names, others might seem obscure to the average consumer. What is the best health insurance company isn’t necessarily the biggest, but here is the list of the 50 largest health insurance companies in the U.S., and a deeper look at each of the top five.

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More Lloyds History By Miller

By Paul Miller

Here is part of an insurance claim made by Mme. Léontine Pauline Aubart, a first-class passenger aboard RMS Titanic.

Throughout her twenties, Mme. Aubart was a nightclub singer, living at 17 Rue Le Sueur, Paris. She boarded the Titanic at Cherbourg with her maid Emma Sägesser, occupying cabin B-35.

Aubart was the mistress of millionaire Benjamin Guggenheim, who was also travelling on the Titanic’s maiden voyage. After the collision, she and her maid entered Lifeboat No. 9. As they clambered aboard, Guggenheim spoke to Mme. Sägesser in German, saying: “We will soon see each other again! It’s just a repair. Tomorrow the Titanic will go on again.”

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Aldeen’s Sunday Morning Bathroom Read (ASO Fiduciary Plan Design 101/Bart Simpson Chalkboard)

A recent review of an Aetna ASO Agreement between a county and Aetna revealed the following provision:

“ASO rates are guaranteed until 10/1/23. If County changes medical and or pharmacy vendors in 2022, all unpaid pharmacy rebates from Aetna will be forfeited.”

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Dear Father, I’m Glad You’re Dead

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart….

Dear Father, Hope you and Mother are doing well since you left many years ago. Others have joined you since and I will too as soon as God allows. I’m happy you and Mother are dead as times have changed and you would be greatly disappointed if you were to come back for a day and read today’s paper as you used to do during your lunch break, coming home for a sandwich and a cold glass of beer in our sitting room while listening to the farm report on Channel 4. I’m glad you’re dead so you won’t have to live this and wonder what’s to come next. Your daughter and I will never forgo the values you and Mother instilled in us as we grew up. I still say “Sir” and fly the American flag in our front yard every day. Rest in Peace Dad!

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