To Comply or Not To Comply, That Is The Question

December 28th, 2020

Hospitals Hate Pricing Transparency

Hospitals failing to comply will be subject to a chump change fine not to exceed $300 per day ($109,500 per year). Plus the government will attempt to embarrass non-complying hospitals by posting notice of the penalty on the government’s CMS website for all the world to see and marvel……..

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Providers Find Silver Lining in “No Surprises Bill”

December 27th, 2020

Why would any provider want to be in-network if they know they will always get more than what a plan pays?

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Government Acts Against Money Interests – Sides With The Common Man

December 25th, 2020

Andrew Jackson – Champion of The Common Man

After years of being stymied by well-funded interests, Congress has agreed to ban one of the most costly and exasperating practices in medicine: surprise medical bills……………

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Oscar Health – San Antonio Market Rates

December 24th, 2020
Under new ICHRA’s employers can pay the cost of individual health insurance plans like Oscar Health . See Oscar’s San Antonio area benefits and rates for 2021.

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What Is Program Insurance?

December 23rd, 2020

“Although not traditionally classed as self-insurance, program business involves an intermediary assuming many of the roles of an insurance company……….”

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Program Managers

December 23rd, 2020

We provide production underwriting services on behalf of Life & Health insurers and managed care organizations for new and renewal business.

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Texas State Board of Pharmacy Has Outlawed Paper Prescriptions?

December 23rd, 2020
    Darrel Pruit, DDS
Attention Texas dental patients. You should read this.

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December 23rd, 2020

Senate Approves Repeal of Health Insurers’ Antitrust Exemption

By Allison Bell

The repeal bill, H.R. 1418, is now heading to the president’s desk. Read More

Printing Money That Has No Value

December 23rd, 2020

Late Monday, both Houses of Congress approved the Consolidated Appropriations Act, 2021 (“CAA”) providing for a sweeping $900 billion rescue package to deliver much-needed relief for small businesses.

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Professional Liability Insurance

December 21st, 2020

Professional liability, also known as Errors and Omissions Insurance (E&O), protects you if you’re sued for negligently performing services, even if you haven’t made a mistake. Coverage also includes defense costs associated with any lawsuit.

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Health Care Providers Eye Self-Funding Opportunities

December 20th, 2020

Health care providers looking to seize opportunities to drive members to their network through their own self-funded products such as hospital owned Community Based Health Plans……………….

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Congress Releases Surprise Billing Compromise

December 20th, 2020

Creates a complex arbitration process between insurers/ self-insured plans and medical providers…………Arbiters are prohibited from taking into account the provider’s “list price” billed charges……………..

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Tom & Sally Vaccinated in 1801 Amidst Pandemic

December 20th, 2020

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The Biblical Alternative to TRS ActiveCare

December 19th, 2020

TRS ActiveCare used to be a great deal for teachers, but unfortunately that’s no longer the case. Alternative choices can provide a better solution for Texas teachers and their families.

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Fully-Insured Prescription Drug Plans

December 19th, 2020

Prescription drug costs continue to escalate. Is it better to fully-insure or self-fund the risk?

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Chinese Flu Vacination Protocol Suggested By Health Policy Expert

December 19th, 2020

“All white people to the back of the bus” screams Harald……………………..

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Egregious Third Party Fees Gained At Provider’s Expense

December 18th, 2020

domino

“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Reference Based Pricing may not make much sense to those in the domino parlor.”

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Move Over BCBS, Aetna, UHC & The Rest – Lisa Gets The Best Prices, Yours Suck

December 17th, 2020

Hey Doc, how much will you charge, cash, for a Carpal Tunnel Release?. If I like it I’ll pay you in full on the day of service……………………or before if you insist.

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Chinese Exports Help Reduce U.S. Health Care Costs

December 17th, 2020

Newest Chinese export benefits corporate coffers worldwide by lowering health care costs for plan sponsors……………….

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World’s Richest Man Bets His Money on Primary Care Strategies

December 17th, 2020

The service would bypass health-insurance plans and brokers and could help to lower the cost of healthcare.

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The Gift of Hardship

December 16th, 2020

The Gift of Hardship by Tatiana Denning is an excellent short 5 minute read of “Our most important life lessons come when difficulties rain upon us.” 

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An Online One-Stop Shop For Small Business’s of 2-300 Employee Lives

December 16th, 2020

An online one-stop shop for small business owners looking for medical coverage for 2 employees up to 300. Read the rest of this entry »

Lawsuits & Class Action – It’s All In The Cards

December 16th, 2020

The District (HOSPITAL) argues the insurance cards failed to adequately disclose that the patient’s ELAP plan contracts with MultiPlan only for physician services, not facility services.

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December 15th, 2020

December 15th, 2020

Surprising New Chinese Flu Test Shows Promising Results

December 13th, 2020

Please wait here in the examing room. Our lab technician will see you in just a few short minutes……

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Centivo Raises $34 Million To Serve Self-Funded Employers

December 13th, 2020

The company will use the financing to expand its offerings into new markets and further scale its operations in response to growing demand……………..

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Holy Cow Mamacita!

December 13th, 2020

In 2013, he made $5 million. Three years earlier, he made $8 million. That’s the kind of money you might expect the CEO of one of the largest hospital chains in the country to earn.

But Ray Ingham isn’t the chief executive of a major health system………………

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Underwriting TRS ActiveCare Alternative Commercial Health Plans

December 13th, 2020

TRS ActiveCare will not release claim experience for those districts who wish to offer a competitive commercial health plan alternative. Since experience rating is not possible in these cases, some other way must be employed to underwrite the risk.

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Oh Oh, The Tape Was Running………………………..

December 12th, 2020

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General Motors To Enter The Insurance Business

December 11th, 2020

The value in the insurance offering comes from GM and OnStar’s ability to leverage the businesses’ already established ecosystems and improve customers’ insurance experiences. ………….

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Rutledge v. Pharmaceutical Care Management Association

December 11th, 2020

Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell | December 10, 2020 at 04:59 PM

The justices held that Arkansas can set payment rules that affect ERISA plans’ pharmacy benefits managers.

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Supreme Court Sides With States in Drug Benefits Ruling

December 10th, 2020

Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell

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$1.1B deal will give Tenet 45 SurgCenter ASCs

December 10th, 2020

Tenet projects the transaction will generate double-digit returns within three years of its completion and 42 percent of Tenet’s adjusted-EBITDA will be generated by USPI’s ambulatory business next year, up from 4 percent in 2014.

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Antidote for Contracts of Adhesion

December 10th, 2020

Quizzify’s offering an elegant solution to fight surprise medical bills.

Download the solution now!

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Major League Sues Insurers Over Chinese Flu Losses

December 10th, 2020

“We strongly believe these losses are covered in full by our insurance policies, and are confident that the court and jury will agree.”

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Social Inflation Hurting Insurance

December 10th, 2020

Increasing litigation, broader definitions of liability, more plaintiff-friendly legal decisions, and larger compensatory jury awards………………….

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Cover Your Ass Insurance

December 9th, 2020

Fast & Easy Application for 180+ Professions – Business & Personal Lines

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Hospital Shopping with Payer Compass RBP

December 9th, 2020

An employer recently asked if there was any difference in the level of Medicare reimbursements for the two hospitals in their community.

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Bulldog Attorney Warrior Opines on Health Care

December 9th, 2020

Doug Aldeen believes commercial insurance plans serve as an ATM for hospitals at the employers and patients expense………..

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Ambulance Trips leave Door Open For High, Unexpected Bills

December 9th, 2020
What are you supposed to do,” asked Pogue, the health policy analyst, “negotiate with the 9-1-1 operator?”

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Public Consulting Group – Valued Resource For Texas School Districts

December 8th, 2020

Founded in 1986 and headquartered in Boston, Massachusetts, PCG helps primarily public sector health, education, and human services organizations make measurable improvements to their performance and processes.

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What Ever Happened To The Texas Health Affiliate Plan?

December 7th, 2020

The plan offered a guarantee cost for three years – Fixed Cost, Claim Cost and Reserves…………..

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Texas School Districts Facing Fiscal Disaster

December 7th, 2020

Teachers have historically complained about poor pay and terrible health benefits. Now many of them point to the life threatening environment of the classroom. “I can’t teach in a Death Chamber” is the message to school district officials and taxpayers. So parents remove their children from the public classroom leading to reduced tax revenues for education, continued crappy health benefits and less pay………….

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Traveling Down Memory Lane

December 6th, 2020

A September 21, 2011 email reminds us of how much Reference Based Pricing strategies has grown here in Texas. This email (a portion of which is shown below) is from RiskManagers.us to a client……..

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Cover Your Ass Insurance

December 6th, 2020

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Provider Network of America (PNOA)

December 6th, 2020

PNOA has mostly Medicare based reimbursements and has achieved aggressive discounts…………

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Study Shows OTC Program Reduced Hospital Admissions By 39%

December 3rd, 2020

A recent study of a population with high health care utilization rates found giving individuals access to over-the-counter care benefits can reduce the number of avoidable ER visits and hospital admissions while improving member satisfaction and saving health plans millions of dollars.

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Physician Is Seriously Pissed

December 2nd, 2020

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Quote & Bind Liability Insurance Online

December 1st, 2020

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Government Mandates Listed Price Must Be Paid By Health Plans

December 1st, 2020

Being out-of-network has never been better! Let’s charge $10,000 for a test that costs $130 and never have to worry about not being paid the full amount………………………..

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AMPS Announces Additional Savings Opportunities

November 30th, 2020

AMPS Webinar: New cost containment strategies on the horizon that will enhance the services offered to your clients………………….

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Health Insurers Make It Easy for Scammers to Steal Millions

November 30th, 2020

Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.

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Gabriel, Roeder, Smith & Company

November 29th, 2020

Founded in 1938, Gabriel, Roeder, Smith & Company (GRS) is a national actuarial and benefits consulting company. GRS is dedicated to bringing clients innovative, sustainable solutions that the company helps put into action.

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AMPS Hiring Sales Executives

November 29th, 2020

AMPS, a rapidly growing healthcare cost containment and risk mitigation company, is expanding its Sales Team. If you are a seasoned sales executive in either the Northeast or Mountain region of the U.S., this is a great opportunity to join a talented team and help achieve our mission of making customers’ healthcare dollars go further.

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WithMe Health Partners With Centivo & Consociate Health

November 29th, 2020

In addition to providing a full-service replacement for traditional PBMs, WithMe Health is launching a medication guidance service that complements plan sponsors’ existing PBM infrastructure by personalizing medication selection and member guidance. The service helps employers and health plans curb their costs while optimizing member experience and outcomes.

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The Hardening Stop Loss Market

November 29th, 2020

“While it’s common to see 20%+ increases in reinsurance this year, both in the last renewal cycle and this one partly driven by leveraged trend, there appear to be fewer new entrants looking to scoop up that business at a loss. So, we have repeatedly found ourselves in situations requiring 30%, 50%, and in some rare cases, even larger increases. Also concerning is the fact that many carriers are curtailing the offer of “no new lasers” contracts.”

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Only in Texas

November 27th, 2020

Texas is the only state in the Union where the majority of Texas businesses can elect to non-subscribe. Thanks to our historical fore fathers, this option has been available since 1913.

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Patient Describes Experience At Methodist – San Antonio

November 25th, 2020
When I asked what the total billed charge for the procedure was going to be, that completely flummoxed them………………….

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Chapter 4: Health Care is Stealing Millennials’ Future, But They Will Take it Back

November 24th, 2020

“Most health plans have merely lipsticked pigs or paved cowpaths rather than rethought health plans for the modern era.” – Dave Chase

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South Texas Consultant Sentenced to Prison for $1M Fraud

November 22nd, 2020

Beware of Insurance Consultants Dress In Orange…………………

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Brownsville Texas Native Makes Fortune In Insurance Business

November 22nd, 2020

Former high school coach makes fortune in the insurance industry……………………….

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“How I Made Millions Off Texas Taxpayers” by Elijah Granger

November 21st, 2020

Texas school superintendent’s $2.25 million buyout threatens district’s finances………………..(Pssst…file this under Poor Risk Managment)

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TRS ActiveCare Alternative Programs: Does it Make Sense for Your District?

November 20th, 2020

Rising Health Insurance Rates………..Cost Shifting To Plan Members……………Less Choice

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Insurance Consultant Wanted

November 19th, 2020

GROUP HEALTH, DENTAL & EMPLOYEE BENEFITS INSURANCE CONSULTING SERVICES

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Let’s Screw 153,000 Young Healthy Workers

November 19th, 2020

CalPERS approved steep rate hikes for its cheapest health insurance plans Tuesday in an effort to save its most expensive plans from collapse…………….price hikes of up to 51% for health plans favored by young, healthy workers

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Amazon Launches Rx Delivery Service

November 19th, 2020

  Retail Pharmacist Reacts To The News

“Members could save up to 80 percent on generics and 40 percent on brand-name medications when paying without insurance, according to Amazon.”

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TRS ActiveCare Fights Back

November 18th, 2020

Is your school district considering offering self-funded health plans to your employees? This document outlines things to consider when making this decision.”

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Will Texas Finally Grow Some Cojones?

November 18th, 2020

The upcoming Texas legislative biennial session is fast approaching and lawmakers will have to address an historic $4.6 billion budget shortfall. “Tell all departments to be prepared to cut their budgets another 5%”  dominates the Austin rumor mill these days. 

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Sidecare Health – Health Insurance That Makes Sense

November 17th, 2020

An innovative and disruptive model designed to turn the industry on its head……….model has been shown to reduce health costs for their members by up to 40%…………members can customize the coverage to their individual needs…………..3 year rate guarantee in certain states…………Insured by

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Employers Eye ICHRA’s

November 16th, 2020

Individual coverage health reimbursement arrangements (ICHRAs), a new employer-sponsored health care benefit program for active employees that became available this year, are drawing the attention of U.S. employers, particularly wholesale and retail employers and those in education and the public sector.

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Is It Essential or Not Essential? It Can’t Be Both…………..

November 12th, 2020

He saved the ACA in 2012 by declaring the individual mandate essential to the survival of Act and then may save the ACA again in 2020 by declaring that the individual mandate is not essential to the survival of the Act……………………….

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City Escapes PPO Cult – Abetted By Renegade Hospital

November 12th, 2020

City terminates UHC and enters into direct contract with local hospital system for significant savings…..

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Veterans Day 2020

November 11th, 2020

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. 

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Full Legal Representation for RBP Plan Members For $4.55 PEPM

November 9th, 2020

TRADITIONAL REFERENCE BASED PRICING VENDOR REACTS TO NEWS

“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

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