We’ve seen little or no outrage over egregious hospital price gouging in years past. Consumers have remained complacent. Yet now we are seeing outrage over minor things like $60 for a bottle of hand sanitizer, or $39.95 for a pair of face masks. Why the outrage now when there was none before?
Alex Fairly
No other RBP vendor can replicate our simple, streamlined approach. Welcome to the next generation of RBP……………………
Emergency room doctors and nurses many of whom are dealing with an onslaught of coronavirus patients and shortages of protective equipment — are now finding out that their compensation is getting cut………………….
RiskMangers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
Superior Access grants independent agents the ability to work from anywhere…………..
CHINESE FLUE – Severe Acute Respiratory Syndrome Coronavirus 2
“From a risk communications perspective, using the name like Chinese Flu can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia…….”
Plan requires members to complete the application process, in good faith, for alternate funding programs…… …
Telemedicine utilization will explode due to current state of affairs. I believe as consumers begin to get used to telemedicine they will like the convenience and continue to use it after this crisis is resolved. Smart brokers are seizing this new sales opportunity. How are they selling it? By telephone of course.
PCA is publishing RFP 3-215-19 Third Party Administration and Insurance Services, 125 Cafeteria Plans, and Related Items.
Overwhelming medical debt is the No. 1 reason Americans file for bankruptcy. In fact, according to a study out of the City University of New York, 66.5 percent of bankruptcy filings cite medical expenses as a contributing factor.
Dr. Vladimir Zelenko has now treated 699 Chinese Flu patients with 100% success using Hydroxychloroquine Sulfate, Zinc and Z-Pak. Dr. Zelenko claims he saw the symptom of shortness of breath resolved within four to six hours after treatment…………………..
By Molly Mulebriar
Brokers should be cautious yet most don’t seem to be as evidenced by the prolific offer and acceptance of “free” Cafeteria Plan administration services, especially among Texas public school districts.
Organ Donor Faces Medical Review Committee
A majority of China’s organ transplants reportedly come from harvesting those of non-consensual “donors”…………….
By Darrell Pruit, DDS
If my suspicion is correct – that aerosol driven from the mouths of patients by dentists’ high speed handpieces can carry the COVID-19 virus – we could be witnessing an alarming increase in dental office closures due to occupational illnesses in the weeks following Easter Sunday services, or even an official “all clear” signal much later.
“A buyback deductible, also called a deductible buyback, can be an add-on to an existing insurance contract or may be purchased separately.” For example, it can be a method to buy down a high deductible health plan specific to certain specified conditions.
He entered the insurance industry in 1964 when he was lured away from selling cars in Harlingen, TX……
School district cuts healthcare spending in half while reducing employee cost-sharing by $1,000. More evidence size doesn’t matter, smart risk management does…………….
Forget what you know about traditional primary care: the inconvenient scheduling, long wait times and increasing expenses. 98point6 is pioneering a new approach to primary care, using technology to bring affordable, on-demand access to everyone—because we think that’s the way it should be.
America needs to establish a Hospital System Super Fund immediately of $300 billion-$600 billion……….
Sun Tzu
Could having a local representative on the ground disguised as a punching bag, gauging and influencing perception and needs among members be the motivation?
As a fee based insurance consultancy, you can imagine our surprise when we opened a letter sent to us in February 2020 from a PBM and found an unsolicited commission check made payable to RiskManagers.
Health Insurance 101
Chapter 1 Correlation Between Provider Reimbursement & Rate Setting
Chapter 1 Takeaway: GREEN IS GOOD, RED IS BAD
By Molly Mulebriar
Provider reimbursement difference between a traditional Managed Care plan (PPO) and a Reference Based Pricing plan is illustrated in the graph above.
“Anyone know what the COVID-19 (Chinese Flu) Medicare CPT codes U0001 and U0002 Medicare payment rates are?” – Bill Rusteberg
“Bill, it’s our understanding those are old codes and fees. They have been updated and there are new fees. We’re trying to get confirmation, but it looks like Medicare will pay $305 for the test. We’ve heard hospitals will charge anywhere from $900-$3,000” – Physician
“Wow our TPA is already seeing cost of test between $2,000 and $3,600. We did decide to go ahead and cover testing under preventative so it is free for employees with our insurance” HR Director
“Our director of health services seem to think the test will run $295″ – HR Director
By Bill Rusteberg
Why do some plan sponsors settle balance bills for their members when they don’t have to in the first place? And when they do why do they often agree to pay significantly more than warranted in medical debt market rates?
YOAKUM, Texas- A male patient was seen on March 7th at the Yoakum Community Hospital who presented mild flu like illness, returning a couple days later (specifics of date was not given) with shortness of breath prompted emergency position on call for the patient to be transferred to an Austin facility to be tested for COVID-19 resulting in a positive testing……………..
“Transmission rates for diseases, and the intensity of an outbreak, are highly dependent on how the pathogen travels between people. Coronaviruses generally can travel up to six feet from an infected person, as they move through respiratory droplets produced through sneezes, coughs or conversations………..”
Hello again everyone!
My book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States is now available for purchase on Amazon Kindle.
A cautionary tale where a self-insured employer health plan implemented a reference-based pricing mechanism…………………
Greg Lindberg and his consultant are continuing to fight allegations that they promised to make improper campaign contributions to the re-election campaign for the North Carolina insurance commissioner.
“Let’s say it hasn’t been tested on this strain of the coronavirus, but it’s been tested on other strains of the coronavirus, and it has been able to eliminate it within 12 hours.”
Texas-based company claims to have developed coronavirus vaccine. The vaccine will first need to be tested on animals, but could be available by the end of the year.
By Bill Rusteberg
Reference Based Pricing plans have been around for many years now. Fear of lawsuits by medical caregivers, particularly hospitals, is a concern for middle and late adapters of the model, causing many to pay a premium for protection. The cost to do so can be significant and out of proportion to the risk assumed.
Cigna and Houston Methodist (New Best Buds) announces a long-term agreement…………..But UHC says Houston Methodist is driving up the cost of health care for the people of Houston………..
Employers are slashing deductibles and copays so more workers will go to primary care doctors — and avoid unnecessary trips to the emergency room………………..
TEACHER RETIREMENT SYSTEM OF TEXAS MEETING BOARD OF TRUSTEES AGENDA February 20, 2020 – 8:00 a.m. February 21, 2020
Receive an update on TRS-ActiveCare district participation, including the potential consequences to TRS-ActiveCare of participating Districts of Innovation (DOI) offering competing health care coverage to their employees and protecting the stability of TRS-ActiveCare – Katrina Daniel
Beginning Sept. 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will serve nearly 1,100 TRS-ActiveCare school districts, plus half a million employees and their families across Texas. Hopes are to increase value by building a primary care health delivery based plan.
By Molly Mulebriar
Believe it or not, most consumers and plan sponsors don’t know anything about Reference Based Pricing strategies and those that think they do have all kinds of misconceptions.
(Walmart) could very easily become a dominant player in cash based medical services very quickly…….
Insurance schemes benefit fewer than many. An earned benefit is not without a loss so the net benefit is less than the earned benefit. All parties to the scheme suffer losses, whether its an indemnified loss or cost-of-risk loss.
An unreported pandemic strikes Texas school districts. Austin based doctors recommend the ostrich approach to health care management………………..
In the fall of 2018, a 300 employee industrial graphics and printing business was referred to our team to help take back control of their health plan. Over the course of the next 12 months, the client realized a reduction in health care spending of over 40%, or about $4,000 per employee per year, without watering down their benefits design. Here’s how…
Aetna Inc., Aetna Life Insurance Co. and Optumhealth Care Solutions Inc. allegedly misused CPT codes to pass on administrative charges under the guise of medical care………….
“Legislative inaction has now led to an insurance program for school district employees that is more burdensome than beneficial, and for many educators, it amounts to a pay cut year after year.”
Coronavirus has jeopardized the “domestic supply of some 150 prescription drugs, including antibiotics, generics, and branded drugs…………..”
The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States.
A self-funded plan using BCBSMN as the Plan Administrator pays out-of-network providers 200% of Medicare. What do they pay in-network providers (Hint: it’s more).
By Bill Rusteberg
Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.
“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”
Turning Bronze Plans into Gold Plans at Bronze Plan costs is a common but unspoken strategy……………but who is benefiting from “beating the system?”
“China’s stated aim is to become the pharmacy to the world with its own companies. And what we’re seeing with Western generic drug companies, they’re collapsing because they can’t compete.”
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?”
“If a hospital (y) later turns down “two times Medicare (2x) and it goes to court, their lawyer is going to say, ‘We could lose this thing……………………..”
200% of Medicare represents a “savings” over a typical 60% PPO discount?
Rather than kicking the can down the road to the next legislative session, sleepy TRS ActiveCare trustees should take note and consider adoption of newer, proven risk management strategies as other risk pools have done……………………….
Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….
Members of the 50% Club subscribe to the Upside Down Economics of Health Care. They understand those who pay on time are screwing themselves and those that don’t are rewarded…………….
You Want How Much!
As Out-Of-Pocket Health Costs Rise, Insured Adults Are Seeking Less Primary Care
“Drug prices are out of control, and Big Pharma continues to raise the prices for all Americans……….Not only does that mean higher prices at the pharmacy counter, it also means higher premiums and other healthcare costs for everyone.”
“It’s time we cut out the middleman and get our citizens the savings they desperately need.”
Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks.
The purpose of this event is to inform employers, brokers, legislators and regulators about emerging initiatives to expand access, improve quality and reduce the cost of health care. – Dan Meylan
The fatality rate may prove to be comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally……………
Under prevalent status quo heath plans, cost containment means higher deductibles, higher out-of-pocket expenses, less choice. All are impediments to health care.
On the other hand, under Reference Based Pricing plans, cost containment means lower deductibles, lower out-of-pocket expenses, more choice. There are less impediments to health care.
The Shield is an ERISA-compliant product that deals with high-dollar medical claims and COMPLETELY PROTECTS the member from balance billing abuses with guaranteed savings.
In summary, the lawsuit alleges that CIGNA accepts the out-of-network provider’s claims at the full billed charges and requests the same amount from the self-insured health plan.
