Mention Reference Based Pricing to a hospital official anywhere and you may experience first hand a human meltdown unfold before your very own eyes……………….
“Burn in hell, you sorry SOBs. Your plan to cut payments to hospitals could possibly be the most moronic idea I have ever seen come out of state government, and since you retardicians have taken power, and that’s saying a lot………….poor people generally don’t vote for your party, so you want them to die.”
The ACA is a naked command to buy an insurance product the government deems suitable,” Texas Solicitor General Kyle Hawkins argued in court papers.
“Bereft of penalties, the mandate now raises no revenue and therefore cannot by any conceivable definition be considered a tax,” he added. “Stripped of its tax status, the individual mandate is nothing more than an unconstitutional congressional mandate to purchase health insurance.”
Since the passage of the ACA un-elected bureaucrats in Washington have been issuing regulations faster than a melting raspa on a deep South Texas afternoon in August. Now the focus is on whorehouse high prescription drug costs…………
Ruling will fundamentally change the way employers provide employee health care benefits……..
Managed Care Castle Under Siege
If current proposals come to fruition, the issue of narrow networks or surprise billing will no longer be the consumers’ problem………providers could be left holding the bag if their ability to negotiate is undermined by disclosing rates to managed care entities …….the need to contract could conceivably be impacted and the foundational concept of managed care could break down.
Is there a single soul who is surprised that an engineer came up with this? The 10,535 pages of the Obama Care legislation reduced to 4 short sentences.
bill that some insurers lobbied quietly to quash made its way through the Legislature and was signed by Gov. Phil Murphy on Sunday.
“The French are on vacation more than they’re at work.” “They can’t wait to get laid off so they can live off generous unemployment.” “They have no ambition.” – (secretsofparis.com) (more…)
“340B is a well-intentioned drug discount program gone awry………..” Has the program departed from its statutory foundation?
“Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns.
HOSPITAL PRICES ARE TOO DAMN HIGH!
Several states have implemented forms of reference pricing for public plans…………..
“The recommendation of this agenda is to recommend to the Board of Trustees the firm that will provide the best value as the Consultant to help guide the district in reviewing options related to our employee benefits program.”
Politicians want to rein in aggressive tactics used by nonprofit hospitals to collect unpaid bills, including suits and garnishing of wages………….
The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.
The El Paso Independent School District (EPISD) is the second Texas public school district ( See Texas School District Challenges TRS ActiveCare Plan Mandates) to challenge TRS ActiveCare by offering district employees a choice between the state sponsored program and a commercial health plan alternative.
HOSPITAL ADMINISTRATORS REACTS
Hospitals and insurers say they are against the idea of transparency. Sunshine adverse, these pasty faced third party intermediaries say transparent pricing will lead to increased costs. That must mean the cost of goods and services in this country can be reduced by adopting health care pricing strategies of Don’t Ask And We Won’t Tell!
The way out of this mess is for Americans to remove themselves from the health insurance market altogether—or to participate in other forms of health insurance such as health sharing ministries and short-term insurance plans. Individuals can actually pay a doctor, hospital, or outpatient center for a service performed without filing claims or getting pre-approval from a clerk in a cubicle.
Frustrated by a lack of response to our previous inquiries among numerous sources we approached (including several well known benefit experts) in seeking a definitive answer to a burning ACA question we have, it was decided by staff to attempt one last hopeful effort in peeling back the regulatory onion in search of the truth. Will Ted and his staff come to the rescue?
“Only about 3 percent of self-insured companies nationally have some form of direct contracts with providers, said the National Business Group on Health.”
Hundreds of millions of dollars and medical care for more than half a million people are at stake in what amounts to a game of chicken over a cut in how much the largest health insurance plan in North Carolina pays for care.
A major new health care and health insurance cost control bill still includes a long agent and broker compensation provision — but senators don’t seem to be eager to talk about it.
“It looks like we are entering the “shipping & handling” awareness phase of healthcare costs.”
Purveyors of Reference Based Pricing strategies can’t seem to agree on what the reference benchmark should be. Thirteen years ago J. Patrick Rooney (1927-2008) said it was 125% of Medicare. Was he right?
The state of North Carolina has received considerable push back from the medical community in their efforts to reign in rising health care costs for public employees. Scheduled to implement Reference Based Pricing strategies beginning January 1, 2020, the state’s medical industry (primarily hospitals) have pushed back so hard there is now doubt the plan will ever take effect.
Sharing plans are not new. They have been around for years. While not insurance, these programs can offer affordable access to health care.
HealthComp Hosts “Lunch & Learn” with H-E-B and Baptist Integrated Health Partners in San Antonio
“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction………”
“How Much Did You Say That Xray’s Gonna Cost?
A little ole housewife with cash in her purse has more bargaining power than Blue Cross, United HealthCare and Aetna combined………………………
SOURCE: Frenkel Benefits
“The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims.
“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.”
Successful pandering to gain voters is best achieved by promising free stuff. Each national election we end up getting more free stuff. And we haven’t yet run out of other people’s money…..Hallelujah!There has not been a competitive health care market for years. Managed care contracts have contributed to that. Some employers have fixed health care buy most haven’t. This blog has written about the former in the past so if you are a regular reader you know exactly what we are talking about.
Ralph Weber
Ralph says bundled health care pre-negotiated cash pricing comes in at an average of 108% of the Medicare rate. That’s a very good number in case you’re wondering……………….
Transparency in health care pricing doesn’t make a whole lot of sense when it’s other people’s money paying for all of this. Who cares what the cost is when all you have to pay is a small co-pay, or some sort of deductible. Then, when you enter that Magical Kingdom called Maximum-Out-Of-Pocket Limit you tend to go crazy in getting more health care to (1) milk it for all it’s worth and (2) revenge against the evil insurance carrier that makes you pay so much in co-pays and deductibles while charging you an arm and a leg in insurance premiums.
Health care pricing transparency does makes sense when Reference Based Pricing strategies are employed. “My plan will pay you $500 for that procedure, so how much will you charge me? Oh, never mind, I think I can find someone else that will do it for $500………………………
If you live anywhere on this planet and need free health insurance that covers pre-existing conditions without any waiting period what so ever, come quickly to California now! No passport needed nor pesky immigration hurdles to jump through. Just cross the border at any point of your choosing, turn yourself in and get a free airplane or bus ticket to the Golden State.
“If you are isolated and lonely, but you have someone that you remember, like nurse April, nurse Tina, or nurse John, and they’re like, ‘Hey, how are you doing?’ And you’re greeted with warmth and love, well yeah, I’m gonna come back”………………Three (lonely) patients visited the hospital 500 times in one year………………..
“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.”
Victor Lustig
“Percentage of savings fees is the greatest fraud foisted upon consumers since Victor Lustig sold the Eiffel Tower in 1925. To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.”
Insurance Brokers Fight For Markets
We received notice / invitation to bid from the McAllen Independent School District along with 211 other vendors shown as email recipients. The brokers among them will be stumbling all over themselves to get quotes from the same four or five markets……………………This is exactly why smart brokers stay away from public RFP’s…………….
“In 2018, Blue Cross members seen at South Florida Sanitas clinics—which opened in late 2015—had 32 percent fewer inpatient admissions, 34 percent fewer outpatient visits and 20 percent fewer emergency room visits compared with members who went to nonaffiliated clinics.”
Status Quo Health Insurance brokers are in for a lot of explaining to do. “Mr. Employer, I’m receiving $340,000 more than the $124,000 I’ve disclosed to you in the past. Plus, if I convince you to renew with your current carrier, I get an additional $25,000 renewal bonus! You OK with that? “
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.
I love this stuff! Targeting signed Broker of Record Letters makes so much more sense than blindly quoting policy renewals, throwing mud against the wall to see what sticks, and “hoping for the best.”
By Bill Rusteberg
Health share plans are growing in popularity these days. Cost is significantly lower than insurance plans as you will see by clicking the link below. However beware these plans are not insurance and there is no guarantee claims will be paid/covered.
By Bill Rusteberg
Hidden fees in health care delivery earned by third party intermediaries can be significant.
Healthcare providers set astronomical, arbitrary prices, and employers and insurers have few options. But a solution is emerging.
Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, the Raymondville Independent School District in deep South Texas has decided to act.
“To attract providers, Washington lawmakers chose a relatively high figure to start: The plan caps payouts at 160 per cent of federal Medicare rates……..”
Plan is expected to be competitive “in part to savings from a cap on rates paid to providers……………..”
The following article reports that “TRS trustees noted the only tools available to them to address rising costs each year are to”:
Really?
Meanwhile, smart plan sponsors have solved the rising cost of health care in Texas and it ain’t by increasing premiums and lowering benefits. Rather, it’s by lowering costs and improving benefits at the same time……sounds crazy doesn’t it?
(The Texas legislature’s answer to addressing rising health care costs is House Bill 3987, that if passed, will authorize a committee to study the issue and report back in two years. But some Texas school districts are not waiting……..)
Health Plans Should Prepare For Plan Fallout Of HHS Rule Requiring Manufacturers Disclose Drug Prices
“As recently as 2000, private payers were paying only 