“What! I thought It was The French Connection!”
A county government in New York has been accessing Canadian prescription drugs through their self-funded health plan since 2004 with savings in the millions of dollars. Now we see more employers considering the same by moving away from traditional Predatory Business Models (PBM’s) as drug prices reach unaffordable levels in this country.
We are looking for the perfect TPA. Some of the qualifications are memorialized here: Selecting a Third Party Administrator.
By Bill Rusteberg
“What color is that orange?” asks the first underwriter. “It’s yellow!” says the second underwriter. “It can’t be! It’s an orange!” responds the first.
ATTENTION EMPLOYERS: Do you have anyone in your health plan who is costing big dollars due to high-cost prescription drugs? The same drug may be significantly less expensive in Canada.
MEDSAVE MANAGEMENT LLC assists self-funded plan sponsors towards obtaining Canadian prescription drugs for plan members.
Some employers are moving away from offering traditional coverage with a provider network and instead are using reference-based pricing for some or all of services they cover.
Article Referred By Brent Evans
There was once a frog who had been captured by his country and put in a cage. As he was a very scared and naive frog, he believed it when told it was for his own good.
How it Works
Employers may have to pay more in 2022. but here’s a solution………
For plan years beginning in 2022, coverage is considered affordable if an employee’s required contribution for self-only coverage does not exceed 9.61% of the employee’s household income.
The Bottom Line: Brokers earn bonuses, vacations to keep companies from switching from Blue Cross
RU-48 was developed in 1980 and came into use in France in 1987. It became available in the United States in 2000. It is on the World Health Organization’s List of Essential Medicines.
Feel-good email brings great news for plan members but threatens plan finances…..
Realizing the decision to purchase will be based on worst case scenario, a broker can deliver the lowest bid every time if he knows how.
We need to know if he’s high. Has he been doing bong hits, blasting rails, chasing the dragon, and/or dropping acid? Is he hopped up on goofballs?
“The former insurance company worker described the experience of gliding under water, half-human and half-fish, as “meditation in motion.”
Who, Me? Nope I Didn’t Do It!
New Jersey Governor says he didn’t intervene in insurer dispute
Cash Pay Level Funded Plan Make Sense
Combining level-funded plans with locked-in cash-pay rates for medical procedures purchased prior to treatment creates an innovative cost containment network strategy for employers.
Amarillo Drug Dealer Earns Billions
Little did anyone imagine a drug dealer in West Texas (you can’t get there from here) would turn into a billion dollar business. It all started with a $21,000 loan from a loving mother.
“Please take the time to watch this compelling case study webinar that showcases what is possible when an employer takes a truly proactive approach to controlling the cost of healthcare claims” – Dan Meylan
Texas-based study raises questions about impact of using additional criteria in No Surprises Act arbitration cases
SOURCE: Howard A Green, MD – Linkedin
Can’t make this shit up. US Congress sneaks into the current gun bill an extension allowing continued kickbacks to insurers pharmaceutical benefit managers screwing patients and their physicians.
Lawyers Professional Liability Insurance
Zurich’s Lawyers Professional Liability Insurance Program offers Professional Liability/Errors and Omissions coverage to the following segments of attorneys: Law firms with attorney count of up to 100 attorneys; solo attorneys; part time attorneys and moonlighting attorneys.
Davita Locations
Certain payors have been attempting to design and implement plans by limiting the number of in-network providers, setting arbitrary provider reimbursement rates,……….
“The question in this case is whether a group health plan that provides limited benefits for outpatient dialysis — but does so uniformly for all plan participants — violates the Medicare Secondary Payer statute. We agree with petitioner Marietta and the United States as amicus curiae that the answer is no.
“There is no excuse for this! Poor risk management, old style remedies and believing in magic is a recipe for disaster!” – Don Pedro
Insurance Commissioner Cassie Brown
Cassie Brown was appointed to serve as Texas insurance commissioner by Governor Greg Abbott in September 2021. She is the chief executive of the Texas Department of Insurance (TDI), overseeing the regulation of the third largest insurance market in the nation and the eighth largest in the world. The agency regulates approximately 2,800 companies and more than 700,000 agents and adjusters.
6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.
In June 2016, only two months after the contract term began, an individual’s claim for an erectile dysfunction compound medication totaled $405,325.43 over three months (more…)
William Jackson Smart was a twice-married, twice-widowed Civil War veteran and father of 14 children……….
A Public Purchasing Seminar – June 22, 23, 24, 2022 – Designed for Public Purchasing Professionals with special emphasis on the latest developments that are essential in public purchasing.
Attorney General Bonta Issues Consumer Alert Following Reports of Hospitals Failing to Inform Patients of Options for Free or Reduced-Price Medical Care
“Only dumb people pay for health insurance in California” – Molly Mulebriar
“Great turnout at TASB Summer Leadership Institute in San Antonio! My presentation was standing room only and about 20 Board Members were listening from the hallway. I’m excited to see so many districts ready to join this movement. Thousands more school employees will have access to affordable health coverage next year.” – Ben Clinton
“Our current system of distribution through independent agents in their brick-and-mortar offices will be largely replaced with digital distribution channels like Goose and Lemonade Insurance startups. That’s the future and the future is now” – Bill Rusteberg
Ranbaxy exploited the FDA’s “abbreviated new drug applications” (ANDAs) in order to secure valuable first-to-file generic status and lucrative 180-day exclusivity that comes with the first-to-file status.
How many Californians have guns? Whatever that number is, a proposed government mandate requiring liability insurance will bring fast and easy bucks to aspiring P&C agents. “George, you own a gun?” is the opening line sales pitch……………”Then you have to buy this policy or go to jail!” is the closing line………………”Sign here!”
Advanced Medical Pricing Solutions (AMPS) offers the consultancy experience, external contacts and integrated solutions you need to make it possible…………..
TDI orders unlicensed insurer, Salvasen Health, to wind down operations in Texas
The Texas Department of Insurance (TDI) issued a consent order (PDF) today requiring Houston-based operation Salvasen Health to stop selling unauthorized health insurance and begin an orderly shutdown.
Cafeteria Plan Administrators offering “Free” administration services in return for selling insurance products earn commissions on insurance policies sold to plan members. Nothing wrong with that, sounds like a good deal. But are there any regulatory issues?
Give Me Your Poor, Your Tired, Your Huddled Employee Masses…………..You may be surprised by how many of your employees are eligible for free hospital care!
KEY TAKEAWAYS:
Dr. Bernard Swift, founder and CEO of Texas MedClinic
Texas MedClinic sold to larger private equity-backed network. The company announced the sale of 20 urgent care clinics to national operator Community Care Partners.
A tankful of Go Farther Gasoline would sure go a long way towards easing the pain at the pump these days…………………..
“Don’t worry, it’s only a scratch. We’ll make it up on the next one or two hospital admissions”
Texas Man Wins Arms Salesman of The Year
There is no other arms salesman on the entire planet even close to what this Gun Salesman of The Year has achieved! He has sold more guns in less time than anyone else in history. His secret sauce? Reverse psychology selling – “Hell, yes, we’re going to take your AR-15, your AK-47…..”
Community Care Partners is a physician owned and managed group of urgent care and primary care clinics serving patients across the United States under the brands Nova Health, SouthStar, Coastal and BestMed Urgent Care.
MyHealthGuide Source: Yottaflow, 6/7/2022
CLEVELAND — Yottaflow is excited to announce brokers and TPAs can now obtain illustrative stop loss quotes instantly from Yottaflow’s quoting partners.
By Doug Aldeen, Attorney at Law
Lawyers are the fourth branch of government: If you cannot legislate or regulate it, litigate it.
Any business that gives advice needs professional liability coverage including insurance agents and consultants active in health care…………………..
The world of medicine is changing faster than ever, with new treatments and technologies being discovered all the time. The Medicine 2042 conference, taking place between June 8-9 in Tel Aviv envisions the future of medicine and science, and what that might look like in the year 2042 and beyond.
“You have provided me with a surprise medical bill. I am providing you a surprise medical payment …………..”
The MGU unit acts as an underwriting manager for various insurance companies for which it primarily underwrites ICOA insurance, Texas Non-Subscriber and related insurance products.
Shortlister – An HR vendor selection community that helps empowered, data-driven technology buyers to find and choose the right vendor.
18 rectal cancer patients were given dostarlimab every three weeks for six months and ended up cancer-free………………………….“I believe this is the first time this has happened in the history of cancer………”
Benefits include unlimited virtual visits with $0 copay and $0 deductibles, capacity to treat over 1,500 conditions, the ability to prescribe medications and write orders for labs, x-rays and other diagnostic tests………………….Dedicated physician, $1 drugs………….
As Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean……………..
“While legal experts say using homeowner’s insurance policies is common in defamation cases, Virginia lawyer Jeremiah Denton told The Post that most policies have a clause that stipulates judgment costs will not be covered.”
“What turned the Joker into Joker was losing his government-subsidized mental health care. His whole life went to shit because the government made him dependent and then pulled the rug out from under him.”
A 400 life case can be underwritten without claims experience or individual health questions? That’s interesting………….Is experience rating becoming a thing of the past? (more…)
Web based real time on-line final rates, immediate firm quotes, no participating requirements, quote down to 10 lives……………………level funding made easy
“On January 18, 2022, State Farm sent an email recruiting its agents for a “unique project”. Consumers’ Research obtained a copy of that email, and we knew we had a duty to alert the public.”
Meet the Vitori Victory© Guarantee, the first of its kind. This health plan savings guarantee will reimburse you up to $1,000,000 if we don’t hit your savings target.*
“How Sweet It Is…………………….!
Pharmacists and wholesalers can import drugs from Canada but only as part of state programs ……………meanwhile, back at the ranch, everyday Americans are importing Canadian drugs for personal use often facilitated by plan sponsors under the personal use doctrine achieving significant savings. An 800 life San Antonio employer ran 12 months of paid drug spend through CANARX and found they could have saved over $800,000………A county government employee health plan has saved millions by importing Canadian drugs for personal use of their plan members since 2004…………….
The most effective way to address the NSA legislation, particularly elements of the IDR process, is to adopt a “pure” RBP plan.
Health Insurance Carrier Stock Performance Has Been Amazing!
The cost for Latuda oral tablet 40 mg is around $1,503 for a supply of 30 tablets according to drugs.com. That’s $50 per pill.
