Category: Uncategorized

Cook’s Children’s Health Care System considers Reference Based Pricing plan members as SELF PAY!

“Your margin is my opportunity” – Jeff Bezos

Reference Based Pricing vendors make millions off hospital Charge-Masters while at the same time throwing stones at the high cost of health care.

The City of McKinney Human Resources Department is seeking an Employee Benefits Consultant to provide professional services related to the overall design and administration of the City’s employee benefits program.

Katie “I’m So Excited” Hopkins earns coveted Prick Loyalty Card after receiving 45th vaccine booster……

Victor Lustic Would Be Proud

“Here’s how drug diversion works: A patient fills a prescription for a medication that is worth several thousand dollars but is paid for by Medicare, Medicaid or insurance. The patient then sells it for a fraction of the list price in cash. The buyer, known as an aggregator, removes the patient information, alters the bottle and sells it to the wholesale distributor, who sells it back to the pharmacy.”

‘Jimmy the Crow” belonged to Hollywood animal trainer Curly Twiford who stole the bird from a nest in the Mojave Desert in 1934 ……

The company says they have hired nearly 20,000 doctors in 2023 alone, according to reports. It also counts an additional 40,000 advanced practice clinicians among its ranks.

Winston’s Rx Two Hat Method – Place hat on corner bedpost. Take a shot every two minutes until you see two hats. Upon awakening if you still have symptoms and see one hat, repeat process.

Who cares! My copay is only $25.

Vertex Pharmaceuticals and CRISPR Therapeutics co-developed the one-time treatment that could cost around $2 million per patient.

“PPO Discounts Are The Best”………………….I Don’t Agree.

By Allison De Paoli

Founder @ Altiqe | Turning Benefits Challenges into Strategic Success | Benefits Expert | Podcast Host | National Speaker

“Compounded Semaglutide Prescribed Online. Semaglutide is the same active ingredient in Wegovy®* and Ozempic®* for only $297 per Month.”

SOURCE: Semaglutide (Active Ingredient in Ozempic®), Prescribed Online (henrymeds.com)

Includes Provider & Medication and No Hidden Fees – No Insurance Needed

Posted on Linkedin by Chris Barakat

There is more than one way to transfer risk. Most plan sponsors think insurance coverage is the only method. They are wrong.

“This is the dirty secret of healthcare benefits… the ‘network’ provider is supposed to negotiate favorable pricing for healthcare services.  They don’t. This fallacy has been thoroughly debunked.  It’s just that not everyone is yet aware of this.”

“For average Danish citizens, Novo’s economic effect means a potentially better market for buying houses, cars and other big-ticket items.”

Independent agents compete against large national brokerage houses all the time. Marsh, Higginbotham, Gallagher, HUB, Willis and all the other Big Boys tout superiority over the little bitty guys in every community across the country. “We have internal resources your local broker doesn’t have” is their branded sales message.

SOURCE: HRA Council – Home

In June, the HRA Council released its 2023 data report on the state of Health Reimbursement Arrangements, including Qualified Small Employer HRAs (QSEHRAs) and Individual Coverage HRAs (ICHRAs). The report shows that between 2022 and 2023, the number of American workers offered insurance through an ICHRA tripled; QSEHRA offerings, only available to small employers with less than 50 employees, doubled.

SOURCE: Implementation of a Canadian Prescription Drug Importation Program | Colorado Department of Health Care Policy & Financing

The Federal Food Drug and Cosmetic Act (FDCA) Section 804 permits importation of prescription drugs from Canada by a pharmacist or wholesaler, provided the drugs meet certain minimum standards, will pose no additional risk to the public’s health and safety, and results in a significant reduction in costs to consumers. HHS can approve a program if these conditions are met.

PR Newswire – November 13, 2023·10 min read

• Continued year over year growth related to our acquisition of Maestro Health
• Further identification and implementation of synergies and opportunities continue as a result of the acquisition
• Veteran industry executive leadership announced along with the addition of a seasoned health care leader to strengthen the Board of Directors
• Focus on acceleration of operating efficiencies and customer growth

The Centers for Medicare & Medicaid Services’ (CMS’) Center for Consumer Information & Insurance Oversight (CCIIO) publishes the Individual Coverage Health Reimbursement Arrangement (ICHRA) Employer Lowest Cost Silver Plan (LCSP) Premium Look-up Table to help stakeholders access individual market Qualified Health Plans (QHPs) LCSP premium data by geographic location.

An Affordable Care Act mechanism intended to help small companies support ACA health insurance for workers is now being used by large companies to satisfy their ACA obligation to provide insurance to employees, under a Trump-induced loophole. They’re saving money, and selling it as enhancing choice.

The markup on drugs is phenomenal. Sensing a new business opportunity, RiskManagers has entered the pharmaceutical business as a self-declared Tylenol wholesale distributor serving hospitals across the Fruited Plains.

Plan Sponsor – “I’m supposed to do what?

Its amazing how many plan sponsors I’ve met have no clue what’s coming their way in less than 30 days from now. That’s really good news for plaintiff attorneys…………

You’re sitting at home wondering if you have a STD. So you head to your mailbox to leave a specimen.

Carlos Juan Finlay

National Doctor’s Day in Cuba – December 3, 2023

On December 3 every year, Cuban doctors celebrate their professional holiday. National Doctor’s Day in Cuba was established to commemorate the birthday of Carlos Juan Finlay, a Cuban physician and epidemiologist who was the first to discover the transmission vector of yellow fever.

ATTN. PLAN MEMBERS – Carry In Your Wallet or Purse At All Times

“Plan members (and the Plan) are completely indemnified against balance billing…….AMI Indemnity, an indemnity captive completely protects the plan and participant from additional legal or financial risk associated with a balance bill.”

It’s hard to keep secrets in the insurance industry but in this instance the TEE Mystery Insurance Program wins the 2023 Best Kept Secret Award. As a GCISD board member recently stated during a TEE presentation, “If you are scared to answer my questions then that right there is a big red flag.”

Founded only 12 years ago, Optum now employs 10% of all American physicians. Optum is a United HealthCare company. Imagine, 90,000 doctors working for an insurance company! Who’d ever thought!

In 1907 the average life expectancy in the U.S. was 47 years old. Five leading causes of death in the U.S. were: 

By Paul MillerPaul Miller

When he left Manchester United to join Real Madrid in 2006, Ferdinand’s United and England teammate David Beckham covered himself at Lloyd’s with a £100 million policy.

By John Petree – Nov 27, 2023

SOURCE: Opinion: TEE Is a True Disruptor and Here To Stay

Within the last few weeks, something big has happened: two public independent school districts in Texas have begun the journey to separate from the Texas Association of School Boards (TASB) and become official partners with the state’s first true alternative service provider, Texans for Excellence in Education (TEE).

South of the line (USA) prescription drugs are more expensive than those purchased north of the line (CANADA).

More Americans are turning to individual health insurance policies because for many of them the government is paying for most of it.

“For many of the almost 50 million people working for the 3.2 million smaller companies in America, family coverage is no longer affordable.

“I can eat all I want because my employer covers Ozympic and Wygovy!”

“At their November meeting, the SEBC noted weight loss medication coverage as a large contributing factor to the deficit.”

Double network revenue turbocharges profits for the non-profits?

“In recent years, BCBS plans opened medical clinics that exclusively serve their members. Premera Blue Cross partnered with Seattle-based Kinwell Medical Group in 2022 to open primary care clinics for its members in Washington state.”

By Marshall Allen

I recently got an interesting email from the clinic manager at a private psychiatry office. She has been reading Never Pay the First Bill and wanted to allow her insured patients to pay cash when the cash price was lower than their insurance company discounts. But she worried her insurance company contracts prevented it.

The Edinburg Independent School District’s self-funded health plan is hemorrhaging. Plan costs have increased 100% over the past five years driven to a large extent by specialty drugs.

The growing role of government in health care finance since 2010

By Tom Daly

Since its enactment in 2010, the Affordable Care Act (ACA) has undergone several significant changes. These alterations reflect efforts to adjust, improve, or challenge various aspects of the law.

Ten states have uninsured rates below 5 percent. What are they doing right?

By Dylan Scott@dylanlscott  Nov 26, 2023

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Universal health care remains an unrealized dream for the United States. But in some parts of the country, the dream has drawn closer to a reality in the 13 years since the Affordable Care Act passed.

By Dutch Rojas

In a bold move shaking up the corporate healthcare scene, many, that’s a lot, large companies are discarding traditional health insurance networks.

Expands current balance billing prohibitions to include ground ambulance services. Rather than applying the independent dispute resolution process, SB 2476 directs TDI to create an emergency service provider balance billing rate database. Health plans must reimburse ground ambulance services at:

Moral hazard in health care is common. Here’s two examples:

A Christian Health Nonprofit Saddled Thousands With Debt as It Built a Family Empire Including a Pot Farm, a Bank and an Airline

by Ryan Gabrielson and J. David McSwane

Despite a history of fraud, one family has thrived in the regulatory no man’s land of health care sharing ministries, where insurance commissioners can’t investigate, federal agencies turn a blind eye and prosecutors reach paltry settlements.

“Think about it: It is just like H&R Block “maximizing your tax refund”… except you and your family are headed to Disney courtesy of the local not for profit facility” – Doug Aldeen

“It’s no longer viable to go it alone and administrative requirements from insurance companies are time-consuming and burdensome. That’s killing things. It’s just so incredibly complex” – Allen Ditto, M.D.

The American health care system is financed through for-profit insurers while a Bismarck health care system is not. American health care is racing towards a major upheaval and the BUCAs know it.

Where else can you get free or almost free health insurance these days? Third party intermediaries like HealthSherpa, Milliman, Nexben, Take Command Health and many others provide enrollment assistance to help make that happen……………

Plan Sponsor Reacts To Lawsuit Brought By Employee Johnny Sixpak

“If you currently participate in [company name]’s Healthcare Plan, you may have a legal claim. Are you a current [company name] employee who has participated in the company’s healthcare plan? You may have a legal claim — and we’d like to speak with you. Contact our office today for a no-obligation, confidential consultation. At Schlichter Bogard, we protect whistleblowers.

Selling health insurance is a tough business. It’s not a created sale, it’s a replacement sale which means relationships must be destroyed before any chance of a sale is possible. Destroying relationships takes time, effort and money.

This reproduction of Lloyd’s Coffee House was put on display in the ’28 Building for the 1951 Festival of Britain.

An injury almost ended Nicole Kidman’s career because insurance became too expensive for her production company to cover.

A typical dental plan today is usually limited to $1,000 to $1,500 annual maximum. The government wants to treat dental care as an Essential Health Benefit with unlimited coverage.

Sales is a profession like no other. Unlike most other professions, salesmen are paid exactly what their worth, nothing more and nothing less. Most are graduates of the School of Hard Knocks.

Employers and unions are getting fed up with the firms they have used for years to help control their spending on prescription drugs—because their costs keep soaring.

The Baskins-Robins “Pick Your Favorite Flavor” Approach To Health Care

By Ich Ra

Why not give your employees a choice of up to 86 different ACA approved plans through four (or more) different brand name insurance companies (instead of just one as you have now) while limiting your contributions to whatever your budget allows on a per employee per month basis?

Below are the provider lookup links for each of the BUCAs:

Mark Cuban is taking on Big Pharma, in a quest to help employers lower drug costs

Watch the Ednburg Independent Insurance Committee learn (1) Their Rx spend is up 26.3% over last year, from $162.79 to $203.21 pepm, (2) International Rx sourcing could save over $600,000 on just one drug alone (Ozempic) and (3) Why Independent claim audits aren’t necessary because “Blue Cross audits every single claim.…..you’re only paying 29.6% of allowed charges.” NOTE: “Allowed Charges” are not billed charges.

The Ben Feldman Cold Call Approach

Juan makes cold calling look easy. Here he demonstrates his unique cold calling approach to setting an appointment with a perfect stranger in less than 45 seconds.

Powered by $5M investment, startup Yuzu Health takes on insurers’ ‘brittle’ technology

By Noah Tong Nov 1, 2023

Entrepreneur Max Kauderer thinks the company he has co-founded, a third-party administrator called Yuzu Health, can disrupt major insurance companies by helping offer small businesses more affordable health plans for its employees.

Sec. 1501.009 of the TEXAS INSURANCE CODE stipulates an independent school district may elect to participate as a small employer without regard to the number of employees in the district.

Warren says companies will save up to 20% on their Workers Compensation insurance by dealing direct with his insurance company. He says you can get a quote and get covered online in minutes.

By Bill Rusteberg

Want to escape punishing government oversight of your employee health plan? Want to reduce or eliminate your second largest company expense? Become a small employer and be happy.

Department of Labor Settles Cross-Plan Offsetting Case

Cross-plan offsetting refers to the practice by which a health plan insurer or TPA recoups alleged overpayments to a healthcare provider under one plan by reducing subsequent payments owed to the same provider or plan participants under a different plan.

Marpai Names Damien Lamendola as Chief Executive Officer to Drive the Next Phase of its Growth; Names Mike Dendy to Board

Article Referred by Mike Dendy

Many Americans are often overpaying for services when they use their insurance…….Why pay $2,400 when you can pay $541? More plan sponsors are adopting cash pay claim strategies……………

The New York State Volunteer Firefighter Enhanced Cancer Disability Benefits Act requires every fire department and company in the state of NY with eligible members must show proof of coverage.

SOURCE: New Report From PeopleKeep Highlights Employers’ Robust Use of ICHRAs to Cover Higher-Tier Health Insurance Plans (benefitslink.com)

SALT LAKE CITY — PeopleKeep, the leader in personalized benefits for small and midsize organizations, released its third annual report on the individual coverage health reimbursement arrangement (ICHRA).

Resolve reviews and reduces medical bills on your behalf. We’ll lower your bills or our service is free. Guaranteed. – Start Lowering Your Bills

In potential cancer breakthrough, newly found ‘kill switch’ triggers death of cancer cells: ‘One-two punch…………………..

Self-serve CarePods use artificial intelligence to screen and diagnose health conditions

Replacing doctors with machines. Next thing you know they’ll be installing self-serve checkout kiosks at the grocery store and self-driving cars to get you there!