Archive for the ‘Uncategorized’ Category

Hospital Official Reacts To RBP- “Burn In Hell You Sorry SOB’s”

Friday, July 12th, 2019

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.”

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Doctor On Demand Going Viral

Thursday, July 11th, 2019

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‘An Arm And A Leg’: The Full Story Of Insulin And Its Cost ― No Sugarcoating It

Thursday, July 11th, 2019

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High Cost Of Insulin Sends Americans To Canada To Stock Up

Wednesday, July 10th, 2019

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Knowing The Answer Before You Ask But Hoping Otherwise

Tuesday, July 9th, 2019

We’re going to start paying you less, are you in or out……..”

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Working The Spread

Monday, July 8th, 2019
A lot has changed since Insulin’s Inventor Sold the Patent for $1.

Inline image

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The Case of The Two Legged Stool

Monday, July 8th, 2019

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.”

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North Korea Reinsurance Broker Launches New Website

Monday, July 8th, 2019

North Korea’s “first” insurance, reinsurance broker launches new website

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Judge Shoots Down Association Plans

Sunday, July 7th, 2019

A federal judge has rejected the Trump administration’s rules for association plans………….

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Proposed Rules Would Affect Prescription Drug Plans

Sunday, July 7th, 2019

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…………

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New Stop Loss Trademark Coined By Client

Friday, July 5th, 2019
“We show up with bells on our balls when you need us the most!”

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Final Rule On Health Reimbursement Arrangements Could Shake Up Markets

Thursday, July 4th, 2019

Ruling will fundamentally change the way employers provide employee health care benefits……..

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Foundational Concept of Managed Care Under Siege

Wednesday, July 3rd, 2019

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.

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OBAMA CARE IN FOUR SENTENCES 

Tuesday, July 2nd, 2019

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.

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State Passes First Third-Party Auditor Bill

Monday, July 1st, 2019

bill that some insurers lobbied quietly to quash made its way through the Legislature and was signed by Gov. Phil Murphy on Sunday.

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French Work Ethic Crosses Atlantic – Lands in New York

Monday, July 1st, 2019

“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…)

Lawsuit Alleges Rx Price Fixing

Sunday, June 30th, 2019

Lawsuit alleges Rx price fixing – read Summary for a synopsis……………..

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Unintended Consequences?

Friday, June 28th, 2019

“340B is a well-intentioned drug discount program gone awry………..” Has the program departed from its statutory foundation?

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Senate Panel Makes Surprisingly Fast Work of ‘Surprise Medical Bills’ Package

Thursday, June 27th, 2019

“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.

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The New HRA Program Is NOT Good for Us

Thursday, June 27th, 2019

A benefits veteran has read the new final regulations. He’s not impressed.

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The High Price of Hospital Care

Wednesday, June 26th, 2019

HOSPITAL PRICES ARE TOO DAMN HIGH!

Several states have implemented forms of reference pricing for public plans…………..

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Brownsville ISD Awards Insurance Consulting Contract

Wednesday, June 26th, 2019

“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.”

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California Legislature OKs Health Insurance Mandate

Tuesday, June 25th, 2019

California to punish (tax) citizens who don’t buy health insurance but will not punish (tax) illegal immigrants. Instead California will provide government funded (taxpayer paid) health insurance to low income young adults coming from anywhere on the planet and living in the U.S. illegally.  (See California – Free Health Insurance For Planet Inhabitants).

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When Patients Can’t Pay, Many Hospitals Are Suing

Tuesday, June 25th, 2019

Politicians want to rein in aggressive tactics used by nonprofit hospitals to collect unpaid bills, including suits and garnishing of wages………….

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About RiskManagers.us

Tuesday, June 25th, 2019

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.

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Reference Based Pricing California Style

Monday, June 24th, 2019
California Assembly Bill No. 72  – OUT OF NETWORK REIMBURSEMENT

Texas School District Chaffs Under Government Health Plan

Sunday, June 23rd, 2019

House Bill 3987 was filed this session to create a committee to review health benefits from TRS, but the bill did not move past the House Pensions, Investments & Services Committee.

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Second Texas School District Challenges TRS ActiveCare Mandate

Saturday, June 22nd, 2019

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.

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President Trump to Issue Executive Order on Health Care Price Transparency

Saturday, June 22nd, 2019

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!

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Gateway to Health Care: The Clerk In The Cubicle

Saturday, June 22nd, 2019

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.

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It’s Xmas In Texas – State Passes “No Credit Ding Law”

Friday, June 21st, 2019

Major boon to Reference Based Pricing plans…………………..

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Will Senator Ted Cruz Come To The Rescue?

Thursday, June 20th, 2019

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?

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Little Ole Gran Ma From Little Ole Montana Teaches The Big Boys A Lesson or Two

Thursday, June 20th, 2019

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Direct Hospital Contracting

Thursday, June 20th, 2019
“Only about 3 percent of self-insured companies nationally have some form of direct contracts with providers, said the National Business Group on Health.

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Game of Chicken – North Carolina Style

Wednesday, June 19th, 2019

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.

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Senators Avoid Agent Comp Topic at Health Cost Bill Hearing

Wednesday, June 19th, 2019

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.

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Why Can’t I Get A Total Price On My Healthcare Procedure Before I Go?

Tuesday, June 18th, 2019

Thomas Farmer

“It looks like we are entering the “shipping & handling” awareness phase of healthcare costs.”

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Was J Patrick Rooney Right?

Monday, June 17th, 2019

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?

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Dendy Opines on North Carolina RBP Fiasco

Monday, June 17th, 2019

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. 

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 John W. Sbrocco

Friday, June 14th, 2019
John W. Sbrocco, CSFS
Healthcare Consultant helping self-funded employers evacuate & reduce medical claims.

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Sharing Plans Gaining Market Traction

Friday, June 14th, 2019

Sharing plans are not new. They have been around for years. While not insurance, these programs can offer affordable access to health care.

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Hungry? Free Lunch in San Antonio June 19!

Thursday, June 13th, 2019

HealthComp Hosts “Lunch & Learn” with H-E-B and Baptist Integrated Health Partners in San Antonio

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Will Judge Demand Marriage Annulment?

Wednesday, June 12th, 2019

Some marriages are just not meant to be…………………..

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Medicare-For-All Gaining Support Among Businesses?

Monday, June 10th, 2019

“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction………”

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The Best Discounts In Health Care Are Not Through Your Health Insurance Company

Saturday, June 8th, 2019

 

 “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………………………

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San Antonio Flu Epidemic Season Is Winter, Spring, Summer & Autumn

Friday, June 7th, 2019

It pays to be sick in San Antonio and Dallas these days………………………

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Recent Trends in Stop Loss Claims

Friday, June 7th, 2019

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.

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Survey Reveals “Me Too” Brokers In The Majority

Thursday, June 6th, 2019

“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.”

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One Election Away From Free Single Payer System

Wednesday, June 5th, 2019
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!

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If We Don’t Fix Health Care Big Government Will

Wednesday, June 5th, 2019

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.

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2020 HSA and ACA NGFP Limits

Tuesday, June 4th, 2019

Government control of health care (a precursor to a single payer system) continues to manifest itself with constant dictates from bureaucrats in Washington. . The newest and latest message from the swamp is “we’ve placed a new limit on what you can save tax free towards your personal healthcare……………….” Our in-box receives numerous daily updates like the one below:

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Health Care Financing 101

Monday, June 3rd, 2019

Massachusetts hospitals stash $1,600,000,000 in offshore accounts…………….

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MediBid is Pleased to Announce Its New Medicare Allowable Lookup

Sunday, June 2nd, 2019

                  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………………. 

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Trump Ready To Force Transparency In Healthcare Pricing With An Executive Order

Thursday, May 30th, 2019

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………………………

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California – Free Health Insurance For Planet Inhabitants

Thursday, May 30th, 2019

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.

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Hospitals Foster Lonely Hearts Club Memberships

Wednesday, May 29th, 2019

“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………………..

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The Cost of Convenience

Monday, May 27th, 2019

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

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Hospitals Dismiss Significance Of Chargemaster Prices?

Monday, May 27th, 2019

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.”

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Are Carriers and PPO Networks Slowly Becoming Obsolete?

Sunday, May 26th, 2019
PPO networks do not offer the savings they were designed for when first introduced to the market over 25 years ago………..The days of the PPO and HMO networks are slowly becoming as obsolete as the rotary phone, because the current system is just not working…………….Reference Based Pricing is going to become the new norm, providing competition in the marketplace and controlling costs……...

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McAllen ISD Invites 212 Vendors To Submit Bids – Chaos & Madness

Saturday, May 25th, 2019

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…………….

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Blue Cross Joins The Doctors Practice Party

Saturday, May 25th, 2019

“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.”

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New Drug Will Bankrupt Your Plan by $2,100,000.00

Saturday, May 25th, 2019

At $2.1 million, newly approved Novartis gene therapy will be world’s most expensive drug

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A Status Quo Broker’s Worst Nightmare Just Happened In D.C.

Friday, May 24th, 2019

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? “

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Memorial Day 2019

Thursday, May 23rd, 2019

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.

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Working Smart – It’s All About Destroying Relationships

Thursday, May 23rd, 2019

By Charles Specht

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.”

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Health Sharing Plans

Thursday, May 23rd, 2019

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.

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Hidden Fees

Tuesday, May 21st, 2019

By Bill Rusteberg

Hidden fees in health care delivery earned by third party intermediaries can be significant.

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‘Sham’ Sharing Ministries Test Faith Of Patients And Insurance Regulators

Tuesday, May 21st, 2019

Texas insurance officials have scheduled a hearing to consider a similar order against Aliera, which has 100,000 members nationwide and reported revenue of $180 million in 2018, documents showed……

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Why Employers Are Getting Screwed In Health Care Pricing

Tuesday, May 21st, 2019

“As recently as 2000, private payers were paying only 10% more than Medicare. Since then, the gap has been growing by leaps and bounds.” That has since grown to 200-300% and as much as 400%……….

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PPOs and the $444 Box of Kleenex

Thursday, May 16th, 2019

Healthcare providers set astronomical, arbitrary prices, and employers and insurers have few options. But a solution is emerging. 

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Texas School District Challenges TRS ActiveCare Plan Mandates

Wednesday, May 15th, 2019

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.

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More TRS ActiveCare Angst Among School Administrators

Monday, May 13th, 2019

Local school districts voice concern over rising costs for health coverage

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Another State Adopts Reference Based Pricing

Monday, May 13th, 2019

“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……………..”

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TRS Strategy To Control Health Care Costs Screws Plan Members

Sunday, May 12th, 2019

The following article reports that “TRS trustees noted the only tools available to them to address rising costs each year are to”:

  1. increase premiums
  2. lower benefits
  3. or a combination of both

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……..)

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Let The Sun Shine In…………………..

Saturday, May 11th, 2019

Health Plans Should Prepare For Plan Fallout Of HHS Rule Requiring Manufacturers Disclose Drug Prices

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