Somehow, hospitals and insurers continue to get away with only providing estimates and not actual prices for their services and procedures. This allows our healthcare system to remain rigged for their profit and to the detriment and demise of patients, families, communities, tax payers, unions, employers, and municipalities across the country.
“I left our CAH almost 8 years ago and started a Direct Primary Care clinic. It operates purely in the free-market economy and is thriving. Small regional hospitals are now coming around to my way of thinking and are now beginning to bundle things like radiology studies, and surgery, etc. to compete with each other for cash business, and it’s making them money and saving patients money. These hospitals have to find loopholes in the bureaucracy to do this (the government and the trillion-dollar insurance companies who control the elected officials in the shadows love the status quo and want prices to stay high).“
Which one are you, a gorilla, chimpanzee or monkey? And are you a cost containment disruptor? Don’t get too comfortable because your seat at the table is temporary…………..
“It’s dinner on the East Coast in less than an hour and people are gonna die!…………Sir, we’ve got a boy on the Hot Line and he thinks he knows something……………!
Mary Lou Retton got $2M from 2018 divorce and maybe millions more in lawsuit over her double hip replacement – yet the Olympic gymnast still raised $500k to cover medical costs after near-death battle with pneumonia………..
Over 30 million Americans rely on Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and community health clinics for healthcare, often as their only contact point.
St. Vincent de Paul (SVdP) is a Dallas-based charitable pharmacy that fills prescriptions and provides free medication for those who otherwise could not afford it. Now, the organization is expanding across Texas and providing medication to those who are homeless or in transitional housing recovering from homelessness through Haven for Hope.
“All of them have such a powerful story,” James said of her reconstructive clients. “Some are young, others older…….Being able to do this for them and seeing them heal is so rewarding.”
A hospital reaches out to a RBP plan expressing their interest in negotiating a direct agreement. That is encouraging since many plan members view the hospital as a preferred hospital in their community.
CMS highlighted how four in five Healthcare.gov customers were able to find coverage for $10 or less per month for the 2024 plan year after subsidies. The agency also credited the Biden Administration for giving out nearly $100 million in Navigator awards, which lets organizations hire staff to help consumers, according to the press release.
“Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profitson up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”
INCREDIBLE STORY from the history pages of Lloyds of London
By Paul Miller
A cat features in this, my favourite story from the Lloyd’s archives. I post it every now and then, for those that haven’t heard it as it’s so extraordinary.
One of the hardest things a consultant can do is fire a client. Today we did just that. It wasn’t an easy decision. This is a client we’ve served for many years, earning deep friendships within the organization that will endure.
As a self employed insurance agent I’ve worked with hundreds of clients over the past 50 years, the result of calling on thousands more in prospecting efforts to gain more business. I’ve met all types of personalities, developing a skill few have. Understanding motivation, goals and interests is secondary to understanding moral and ethical values of those you strive to do business with.
“Recognizing the key challenge of paying for the fixed costs of rural healthcare practices and facilities, government-induced and -subsidized capacity should focus on meeting what rural residents need the most, such as supporting primary care……….”
In August of 2023, Advent Health fled a lawsuit alleging that MultiPlan’s business model of contracting with fellow payers and aggressively repricing out-of-network service payments is anticompetitive under Section 1 of the Sherman Act.
Government has been known to mandate certain life saving vaccines quickly, without years and years of clinical trials hobbled by a burdensome administrative state about as efficient as the U.S. postal service. Cancer patients dealt a death sentence wonder why a vaccine that’s been around for over a decade with a promising cure rate can’t be made widely available right now, before death do they part cancer’s death row.
“Considering that drugs like Eliquis have net prices that are a fraction of the list prices – with so many of those rebates going to government programs – if the committee wants answers for why the prices are so high, maybe instead of pharma execs, they should subpoena a mirror” – Antonio Ciaccia
Terri Raimondi – Senior Vice President, Business Development and Marketing
Benefit Administrators is progressive and committed—an authoritative Third Party Administrator known for flexible, innovative solutions and unparalleled customer service.
Want one of those expensive employer paid weight loss drugs that’s bankrupting health plans without having to go through all the usual hassles of taking time off for work to see a doctor for a prescription? Now you can……………..
“Congress and state legislatures should consider allowing insurance plans not to cover common generic drugs. This move would fundamentally resolve the spread pricing problem created by pharmacy benefit managers, eliminate wasteful spending on these drugs and lower insurance premiums for all.”
‘That’s an incredible victory! But like many of these wins, it’s bittersweet, because it exposes an outrage. Neither the hospital nor the insurer had been complying with the Illinois law.”
With the price of GLP-1s reaching well over $1000 a month, local officials are warning that rising costs threaten to quickly drain government spending accounts.
What is the No Surprises Act?“It’s a law that transfers balance billing liability from plan members to plan sponsors under certain circumstances gifting the balance biller a much better opportunity to recoup from a deep pocketed plan sponsor than from a Joe Sixpak.” Bill Rusteberg
In April, 1936, a piece of paper was passed around the Underwriting Room at Lloyd’s of London bearing at the top the notation “Queen Mary — £4,800,000”.
You saw the media frenzy on Fox. – After 11 years of private testing, Conolidine “Nature’s Morphine” is now legal worldwide.
After a 100,000 person clinical analysis Conolidine is nowcertified as the most powerful natural pain reliever in the world…. Boasting pharmaceutical level relief with no negative effects.
Health insurance brokerage is nasty business. It’s a replacement sale reliant upon destroying relationships. For some anything goes, colored under the heading “All Is Fair In War.” The good news is sometimes the good guys win. So how are they able to do that?
Tom, Dick and Harry go to the same drug store to pick up the same drug, through the same PBM, on the same day. Each is asked to pick their price behind doors number 1, 2, 3, 4, or 5. Tom picks Door #1 much to the pharmacist’s displeasure. Dick picks Door #3 as the pharmacist nods approval. Harry picks Door #5 and the pharmacist belts out a joyful YES!
In healthcare and elsewhere, the price of services and products is determined by the relative bargaining power between the buyer and the seller. A top dog can afford to walk away without entering the transaction, whereas an underdog cannot. Being the top dog or the underdog makes all the difference for prices in healthcare.
“How Much Do You Charge?” is a question that invariably enters the conversation when meeting a prospective client for the first time. So in 2014 we published our fee schedule for all to see and marvel.
NEW YORK — Marpai, Inc., an independent national Third-Party Administration company transforming the $22 billion TPA market supporting self-funded employer health plans, announced the appointment of John Powers as the Company’s President. Powers is an accomplished healthcare benefits executive with over 30 years’ experience. Powers was previously CEO of Homestead Smart Health Plans.
“The Lower Rio Grande Valley,like many other communities in the United States, is facing a diabetes epidemic. The growing health crisis of widespread diabetes threatens individuals, families, the health system, and the prosperity of the Rio Grande Valley community.” SOURCE: Preventing Diabetes in the Rio Grande Valley – FSG
A WHINY COLLEGE PROFESSOR POSTED THE FOLLOWING ON LINKEDIN:
“Stanford University moved its health insurance from California Blue Shield to Aetna. It is now January 9, and I have yet to receive a card showing my member number, which is the evidence of coverage virtually every pharmacy and medical provider demands in order to get service.”
“As the call for clearer prescription drug pricing has grown, there could be significant shifts in the prescription drug landscape in the coming years … Concerns have arisen around manufacturers potentially raising costs for non-Medicare plans to recoup lost revenue from IRA price negotiations. … There are several situations that could result in increased or decreased costs for plan sponsors in addition to potential price shifting.”
Those of us in the health benefits field know Walgreens as one of the most expensive prescription drug retail outlets on the planet. Most of our clients have eliminated Walgreens from their network.
If your company offers health insurance benefits, then you most likely have a department of people that oversees the program. But did you know that if one of them makes a mistake your company could be held liable?
Recently, Big Pharma and Big Government have teamed up in a full-blown attack against free market solutions in the prescription drug market by focusing on Pharmacy Benefit Managers (PBMs) – which currently serve as the only real check on big pharmaceutical companies’ ability to set sky-high prices for prescription drugs.
If you’ve learned a lot about leadership and making a movement, then let’s watch a movement happen, start to finish, in under 3 minutes, and dissect some lessons:
As members of Congress get back to business after the holidays, they seem to be poised to pass legislation that would address some of the abuses of pharmacy benefit managers (PBMs), the middlemen who extract so much money from the pharmaceutical supply chain.
By Molly Gamble – There are many organizations in the United States that hold themselves out as advocacy organizations for better care for patients, but is that what they are really about?
By night, Joe Ades dines with his fourth wife at exclusive restaurants, sips Veuve Clicquot at the Pierre, and goes home to a three-bedroom Park Avenue apartment. By day, he is something else altogether. At 72, the “peeler guy” in the Turnbull & Asser shirts is a New York legend.