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……………..
“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……………
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.
Texas based university is seeking competitive proposals for TPA services to administer a dual option Reference Based Pricing plan / PPO plan.
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.
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.
But No One Is Listening
Why do self-funded plans hide behind a logo? Employers who self-finance their employee benefit program almost always do.
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.”
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)
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.
Pharmaceutical Manufacturer Concocts New Patented Drug
PBMs have been under increased scrutiny as a potential contributor to runaway healthcare costs.
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.
Texas school district implements two-way video office visit program during school hours for 32,000 Texas school children…………………..
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.”
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.
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…………..
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.
Status quo strategies used to reduce health care spend by employers includes cost shifting to plan members. Higher deductibles and higher out-of-pocket costs reduces insurance premium costs but not health care costs.
Back in the day a health insurance deductible equaled one week’s worth of pay. A $100 deductible was standard back in 1975.
Now it’s not uncommon to see annual deductibles of $4000 and more, much more.
It’s evident cost shifting has not tamed the healthcare beast.
And it’s clearly evident size doesn’t matter. A +400,000 life self-funded health plan in Texas has been practicing cost shifting for years. 64% of plan members are on a $2,750 front end deductible with no first dollar coverage (except for preventive care) before benefits are paid.
The Arthur J Gallagher 10k 145 page report for the fiscal year ending December 31, 2018 provides interesting insight into insurance brokerage services.
Status Quo Broker Reacts
THE STRATEGY
Allow providers to name their price and mold the member and plan responsibility around that.
“Paying cash to see the doctor out of network cost less than half of seeing the same doctor in-network with insurance.”
Plan sponsors should adopt cash pay strategies as many of our clients have done with good success. Whereas a typical PPO plan will pay (with your money) as much as 225% – 400% of Medicare, our cash pay program pays ( with your money) Medicare rates or below on average.
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
Learn a foreign language in the comfort of your home! You will be glad you did! Never again scratch your head and wonder what the heck that health insurance salesman was trying to convey during those dreadful renewal meetings. Stop relying on body language! Become empowered NOW!
Hello Americans. I’m Paul Harvey. You know what the news is —– in a minute you’re going to hear the rest of the story……………………..
At 20 years old Eric started a hospital charity to benefit children in need of health care. It was a noble endeavor. In less than 10 years, he raised more than $20 million for terminally ill children at Saint Jude Children’s Research Hospital in New York. His charity maintained just over a 9 percent cumulative expense ratio, one of the lowest expense ratios of any charity in the nation, and funded the construction of one of the most cutting edge intensive care units and surgery centers dedicated to children.
Many hospitals are more interested in extracting money from vulnerable patients than providing quality care at a fair price………………but greedy healthcare participants like hospitals don’t have quite as much leverage as they’d like us to think………………..
Your BCBS renewal could be the beneficiary of a reserve buy-down in 2020 which means lower than normal rate increases. New business rates should be below market too. That’s because “A $1.7 billion tax refund under the Trump administration’s tax cuts drove a 226 percent rise in net income to $4.1 billion, from $1.3 billion the year earlier.”
By Molly Mulebriar
There appears to be some confusion these days as to rightful owner of the title God Father of Reference Based Pricing.
Texas Department of Insurance estimates that Aliera has about 17,000 customers in Texas and 100,000 nationwide.
“Americans usually put relationships ahead of money” because the money is not really theirs. “Once patients find a physician they trust and a hospital they like, they tend to stick with them even if there is a lower-cost alternative nearby” because, after all, they use Other People’s Money. No one ever cares about health care costs when using Other People’s Money (insurance). Transparency be damned………………………
By Molly Mulebriar
How many times has an employer said to you “Yes, we ARE having issues with our TPA, but changing to another one is too disruptive and challenging. Plus, we are out of time since our renewal is just around the corner. We are just going to stay put for now and live with it.” (more…)
By Carl C. Schuessler, Jr., DHP, DIA, GBDS
Organized crime – this is killing diabetics…………………
Do retail pharmacies make more or less money through PBM contracts? If they make less money is it to a point they lose money? Or do they profit? Before asking your pharmacist, try this experiment first.
Founded in 1983, BAS is a results-driven third party administrator with a track record of delivering cost savings and customer satisfaction. We utilize our services, tools, and partners to create a robust partially self-funded plan as unique as each client.
UnitedHealth Group Inc. will lose two large customers in its retiree health-care business next year, a setback for the insurer in an increasingly competitive marketplace for senior medical benefits.
Formerly sleepy TRS trustees are considering “big changes” to TRS ActiveCare because member districts are threatening to leave to establish their own health plans. Competition, for the first time, is clearly at play here (Texas School District Challenges TRS ActiveCare Plan Mandates).
The TRS solution? Eliminate community rating so some districts can pay more and utilize narrow networks so all districts have less choice……………………..
Lord Roberts -Protector & Defender of ObamaCare
“In court in July, only two of the three judges … asked questions. ‘Oral argument in front of the circuit went about as badly for the defenders of the [ACA] as it could have gone,’ says Nicholas Bagley, a professor of law at the University of Michigan.
Specialty drugs can cost hundreds of thousands of dollars per member per year, or more. One new specialty drug approved this year costs +$2,000,000 for an annual treatment………
Carl Schuessler is set to speak at the upcoming Texas Public Policy Foundation event in January, 2020 in Austin, Texas. The panel discussion is on “The Way Out of America’s Broken Health Insurance System.” Knowing Carl as we do, his message may be “Grow Cojones For (a) Change.”
We have reached a tipping point in the battle against high cost health care. Employers have run out of money to pay for it. Employees can’t afford to use their health insurance anymore. Meanwhile hospitals continue to game the system with egregious charge-master pricing and their disco-discount game with their carrier partners. They have effectively dug their grave and are about to be pushed into it……………..
Proposal will take Colorado down several relatively untraveled roads, potentially creating a health insurance market like no other in the country that could become a national model — or a cautionary tale……………..
Earning commissions forever by simply making an introduction beats working for a living………….
AMPS saw significant growth in its large customer portfolio this year, including customers with upwards of 150,000 members. The growth from small to midsize to large customers reflects broad embrace by employers and health systems……………..
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.
Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….
According to one source, Hartford Life Insurance estimated that one-quarter of all Fortune 500 companies have COLI policies, which cover the lives of about 5 million employees.
Can proceeds go to reduce GASB 45 ?
SOURCE: Trucker Huss
“The chief advantage of offering an ICHRA as opposed to traditional employer-sponsored group health plan coverage is that it transfers much of the financial risk from the employer to the individual marketplace, thus allowing for more predictable costs for the employer from year to year…….
Indiana Jones (Michael Hicks) Sounds Alarm
“What I discovered will deeply anger every Hoosier and should embarrass most hospital administrators and board members. I also expect it to cause significant changes to state policy with respect to these hospitals. This is likely to change the way we tax them, regulate their competitors and enforce anti-trust laws. It will surely lead to civil litigation involving billions of dollars of excess profits.”
Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the self-insurance industry, announced a comprehensive cost containment solutions suite that will help self-funded employers significantly control healthcare costs in 2020……………..
A new government approved group health plan through which employees may purchase individual health insurance on the open market may have a significant impact in the employee benefits arena.
Centers for Medicare & Medicaid Services Administrator Seema Verma warned insurers to shape up or face the consequences of “Medicare for All.”
“El Paso ISD found a novel way to migrate most of its staff out of the state’s program and onto a new local plan…………In response to El Paso’s decision and with the expectation that other districts may pursue a similar course of action, TRS is now looking into the possibility of regional options for school district employees.” (more…)
A “revolutionary” new class of cancer drug that can treat a wide range of tumours has been approved for use in Europe for the first time.
