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.

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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.

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Psst……Have You Heard About Distilled Concepts?

These guys are marketing geniuses – well done website effectively sends the message that health plans can be made better……………..It starts with a Spark………..

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The creator of The Schuessler Stick™, Carl Schuessler explains his success in building a rural community health care plan while freezing his ass off in a Georgia deer blind. Listen to Carl starting at 8:00 – 20:30.

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Texas school districts enrolled in TRS ActiveCare have not had competitive options available to them until now. No matter how large a risk pool is, economies of scale doesn’t matter when risk management systemically fails to adopt proven strategies in a dynamic and changing market.

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“We have budgeted $2 million for our employee health insurance plan. Build me a plan  for my 350 employees that doesn’t cost a penny more than that!” was the directive from the CEO, a Type A personality who doesn’t take “no” for an answer and expects results even if impossible. So we did……………..

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“It is a common misconception that clients are entitled to receive any data, at any time, simply by virtue of being self-insured and having elected to receive Protected Health Information (PHI). This is not the case…….”

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High deductibles are road blocks to needed health care and do nothing to impact health care costs. Smart employers are discovering they can improve benefits and lower costs at the same time. The following article referred by Dan Meylan describes the problem we all face to these man made barriers to health care……………..

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Dr. Rebecca is passionate about providing holistic primary care to families. She understands that healthcare is expensive, which is why she is starting her practice with an innovative new model called “Direct Primary Care.”

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Inspectors found that Medicare Advantage insurers had added diagnoses for diabetes, heart disease and other conditions in 99.3% of chart reviews of patient information…………….

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Click on the link below and learn how Bartlett successfully moved the State of Montana state health plan over to Reference Based Pricing……………..It’s all about Rational Analytics and ARM TWISTING…..

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From: Bill Smith, President, Cigna Group Insurance [mailto:businesscommunications@cigna.com]
Sent: Wednesday, December 18, 2019 12:03 PM
To:
Subject: Important news from Bill Smith, President, Cigna Group Insurance

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David John Rendall
March 19, 1937 – January 1, 2020

David used his marketing skills and passion for deal making to start several healthcare related businesses that have evolved into a large enterprise, which currently has operations in 4 continents and clients in over 80 countries.

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Congress showers health care industry with multibillion-dollar victory after wagging finger at it for much of 2019

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“The emergence of biologics and gene specific medications will serve to drive these increases further as we move forward, as evidenced by Zolgensma (treats Spinal Muscular Atrophy) at an estimated $2.1 million and Luxturna (gene therapy for a retinal disease) at an estimated $850,000.”

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Posted by: MBJ Newswires in Insurance, Newsmakers 01/06/2020

Stephen Cali is joining HUB International’s Employee Benefits division, accepting the role of Sr. Vice President / Sr. Benefits Consultant.

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“The problem is moral hazard in an administrative state………..people alter behavior when they don’t have to pay for something………”

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Market Evolution of Reference Based Pricing Plans

Timing is everything when it comes to new and innovative ideas in health care delivery as the market must be ready and receptive. In 2005 it wasn’t……………..But two years later it slowly took hold in Texas…………And we were ready.

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Cigna Sued for RICO Violations, “Brazen Embezzlement and Conversion Scheme” -Health Plan Litigation Tsunami: Part 2

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Primary care has revived as it is viewed as a less expensive way to lower downstream health care spending. 

“Although maybe only 5% of health care cost is incurred in the primary [care] environment, a good or bad decision determines what the next 95% looks like”

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“Health-plan participants could conceivably choose to challenge health-plan fees with general fiduciary-breach claims. In fact, it is reasonable to expect that such claims will be made against other health-plan sponsors, given that plaintiffs’ firms have begun to solicit potential class representatives and request health-plan fee information from employers.”

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The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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For over 30 years I have helped individuals and corporations obtain the best  ways of paying for medical care. 

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Doctors would be paid at the Medicare level while hospitals would be reimbursed at 110% of Medicare’s rate………..

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Whenever I give a talk about healthcare, I ask the audience, “What is the worst addiction problem we have in the United States?”

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Health care is a business like any other, and it can follow good business principles. Like other industries it can benefit from bottom-up innovation by entrepreneurs and intrapreneurs, rather than rely solely on top-down reforms coming out of Washington, DC. That’s what this book is about.  

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If this passes it will have a profound effect on the future of employer sponsored health plans………no longer held hostage to jobs they hate but need for health care benefits, plan members will be able to control their own health care benefit decisions………..

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You are invited to the following event:

FREE MARKET MEDICAL ASSOCIATION, AUSTIN CHAPTER – JANUARY MEETING

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Tomorrow will mark a new plan year for one of our long time clients, the first political subdivision in Texas to adopt Reference Based Pricing more than ten years ago in lieu of traditional managed care strategies employed by most plan sponsors today.

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Patients qualifying for free care from one hospital might receive painful bills and lawsuits from another.

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In 1990 there were only 10 specialty drugs on the market. Now there are more than 300 with nearly 700 more reportedly under development……………………..Managing domestic specialty  drug costs is impossible unless one adopts the Hot Potato Method, likes to visit foreign countries or Uncle Sam steps in…………..

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The specialty drug solution?  Require providers to buy from us…….

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A 50% discount off double the price? Or is it now a 50% discount off triple the price?

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Charged with bribes and kickbacks in exchange for sending patient nasal swabs to a laboratory for testing………………..

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Your Charges Are Too Damn High!

“Methodist isn’t just the most expensive health system in Texas. It’s one of the most expensive in the entire country……………………… Methodist costs 49% more than other top hospitals in Texas”

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The doctor’s office kept assuring Kasdan by phone and by email that the tests and charges were perfectly normal. The office sent a courier to her house to pick up the check…………..

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Some of America’s biggest companies are middlemen who profit from the system’s wastefulness….

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“The game’s primary problem is that it is all predicated on the existence of, and reliance upon, fake prices. Fake prices for brand-name drugs beget fake prices for generic drugs……………”

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data.medicaid.gov/Drug-Pricing-and-Payment/NADAC-National-Average-Drug-Acquisition-Cost-/a4y5-998d

The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.

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Health insurance brokerage can be lucrative especially if one picks the right horse. For example, several years ago one of the highest earning horses of that year’s Brokerage Derby Bonus Race was BCBS (BCBS To Pay $50,000 Broker Sales Incentive Each Fully Insured Group Sold).

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Before bidding on a political subdivision, it’s wise to do your homework first. What has been their bidding history? How were past decisions to award made? How was the process handled? Was a consultant involved, and if so, who was it? (Insurance Consultants Are Biased).

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Cross border drug trafficking importation increases under President Trump’s watch – The Canadian connection…………………..

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PPO PATIENTS ARE PUPPETS ON A STRING

“We’re not sure what to do next. We have to wait for them to tell us what to do,” he said. “We’re just kind of in limbo….……………

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EMPLOYEES THINK EMPLOYERS PAY FOR HEALTH INSURANCE

Group health insurance average % of health care spend is 8-12% of payroll. If true, his article lends credence that employees pay all the cost of health care in the form of lower wages and less take home pay……………..

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“Californians Without Health Insurance Will Pay A Penalty — Or Not.” What! What about illegal aliens who California has promised free health insurance? Do they pay a penalty too? Not according to this article. They are the “Nots.” But for the rest of us health insurance in California isn’t free whether you take it or not……………

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“Many of the players named in the indictment are shocked to the allegations……………”

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Remember back in the day when health care providers were paid directly, quickly and in cash? Gone were the vast armies of third party intermediaries driving up costs we see today.

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Texas based university is seeking competitive proposals for TPA services to administer a dual option Reference Based Pricing plan / PPO plan.

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In a previous post we discussed Hiding Behind A Logo and why self-funded plans should stop doing so. Plan members need to know who the real “insurance company” is, because it’s not who they think it is.

There are real advantages to understanding the difference, both to the plan sponsor and plan members.

For example, changing plans is never fun, with a lot of disruption and employee re-education. It’s HR’s worst nightmare. Besides, changing logos on an I.D. card doesn’t save money. However when you brand a plan for exactly what it is, changing a backroom claim administrator is as painless as changing stop loss carriers. It’s seamless and not at all disruptive to plan members.

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The Benefits Manager is responsible for directing and planning the day-to-day operations of the University of the Incarnate Word’s self-funded medical and dental plans, other ancillary insurance benefits, and the 403(b) retirement plans.

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             But No One Is Listening

We need to bring sanity back to health care financing. We need to stop the intimidation………

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Why do self-funded plans hide behind a logo? Employers who self-finance their employee benefit program almost always do.

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Imagine going to a restaurant and having a nice dinner. You get the bill. Everything looks good except there is a facility fee added at the bottom. A facility fee? What’s that you ask. “Its what we charge for you to use our facility” says the waiter………………”Our new owner says it’s necessary.”

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Teachers are crying foul about health insurance costs that eat into their salaries………………….

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Dr. Jorge Zamora-Quezada

“Zamora-Quezada is accused of using his million-dollar private jet or his Maserati to go between his offices in the Rio Grande Valley and San Antonio, and of using proceeds from the alleged fraud to buy private jets, luxury vehicles, high-end clothing and real estate in the United States and Mexico.” (KSAT)

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A step by step guide to earning your first billion in American health care…………….

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Medicare ties reimbursement to cost, health insurance doesn’t. That’s the difference………

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By Molly Mulebriar

The picture above (on Linkedin this morning) reminded me of an infamous Texas based TPA known for preying upon mostly rural, clueless employers by hiding turbocharged TPA fees on the claim side of the ledger instead of the fixed cost side of the ledger. These clueless employers don’t read their contracts………………or don’t know any better, or both.

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Pharmaceutical Manufacturer Concocts New Patented Drug 

PBMs have been under increased scrutiny as a potential contributor to runaway healthcare costs.

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Israeli scientists find way to treat deadly pancreatic cancer in 14 days. The tumor in one mouse that was injected with human cancer cells completely disappeared.

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160,000 American citizens offered a $500 cash payout, plane tickets to San Diego and free transportation to Tijuana to receive free health care services. Meanwhile California announces free health care for Mexican citizens who enter the state illegally…………

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Texas school district implements two-way video office visit program during school hours for 32,000 Texas school children…………………..

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SOURCE: Fisher Phillips

“Mere days before San Antonio’s Sick and Safe Leave ordinance was set to go into effect, the law was once again put on hold…. Bexar County Judge Peter Sakai temporarily delayed the start of the paid leave ordinance, which was set to take effect on December 1.”

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FOR IMMEDIATE RELEASE

November 20, 2019 Contact: Bob Serber
rserber@hhcgroup.com
(301) 963-0762 ext. 163

H.H.C. GROUP RELEASES 2019 CLIENT SURVEY RESULTS

H.H.C. Group has released the results of its annual client survey. The survey is designed to assess the company’s performance and help identify its clients’ greatest needs and concerns going into 2020.

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When you came in here you claimed you can SAVE US MONEY. But you really can’t can you? 

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Hospitals Can Bypass New Price Transparency Rules For A Price

Why are hospitals making all the fuss about the new price transparency rules announced by HHS?  Instead they would be wise to remain silent and fund $300 per day ($109,500 per year) into their “Government Punishment Fund” as an additional cost of doing business.

This is a perfect example of Winning By Losing…………..

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The purpose of this event is to inform and educate federal legislators and regulators on the merits and benefits of Direct Primary Care and the impact that Direct Primary Care can have on rising health care costs.

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