Later this year, Texas-based employers will be able to choose our all-new benefit design created to help self-funded groups eliminate cost barriers along the consumer health journey.
“When it suited them, they could be a private nonprofit……….When it didn’t suit them, they could jump back into being a government entity — although there was no government involved.”
The San Antonio Independent School District (SAISD) requests interested parties to submit proposals for “Employee Benefits Consulting Services”. This award is contingent upon funding and no guarantee of a minimum amount of work is implied or expressed by this Request for Proposals. Services required shall be determined solely by the needs of the District.
Article Referred By Doug Aldeen Which Somehow Has Something To Do With The American Healthcare Delivery System (although we don’t know what)
On April 5, 1996, this Court ordered Plaintiff to show cause why this Court should not impose Rule 11 sanctions upon him for filing a motion for improper purposes. The motion which Plaintiff filed was entitled “Motion to Kiss My Ass” (Doc. 107) in which he moved “all Americans at large and one corrupt Judge Smith [to] kiss my got [sic] damn ass………………………..”
The lawsuits alleged a conspiracy among Blue Cross and its members to curb competition, driving up the cost of insurance and driving down reimbursements.
More plan sponsors are saying ENOUGH IS ENOUGH ALREADY! Eliminating brand name and specialty drugs completely, leaving over 12,000 FDA approved generic drugs is an option more plans are considering.
“It was rough in the beginning because we all get this programmed in our head that magic insurance is gonna pay for everything and we have no responsibility…..”
By Julie Selesnick, Senior Counsel at Berger Montague
Seriously, all the handwringing over how complex our healthcare system is and why cost containment is so difficult is silly—the answers are pretty obvious.
If you haven’t already, everyone involved with employer-sponsored healthcare should read and understand this lawsuit (Lewandowski v. Johnson and Johnson) filed by an employee against Johnson & Johnson’s health plan. The key allegation is that the J&J health plan failed in its fiduciary responsibility to design and oversee a health plan that benefits members and pays reasonable rates for services.
“Here it is folks, the case everyone has been waiting for: an employer has been sued for breaches of their fiduciary duty under ERISA by a plan participant for the drug costs in their self-funded health plan.“
Setup: Providers (red) make a choice “Play nice” or “Play dirty” represented by the left and right columns and receive RED payouts. Payers make the same choice represented by the top and bottom rows and receive BLACK payouts
Starting from November 20th, 2023, every household in the U.S. can order eight “free” at-home Covid-19 tests (four for those that already ordered this fall). How much taxpayers paid for these tests remains undisclosed.
The Great Aldeeni is on to something! – Open an Aldeen Miracle Grow Bank Account today and receive a bag of carrots and a free trip to Disney Land! – The H&R Block of IRC 501r? Take it public – The IPO has got to be a record breaker – Will the Great Aldeeni offer franchise opportunities? Count me in………..
“I would set up a booth in every grocery store across the US (much like H&R Block and its ubiquitous “tax refund” stands) and charge a flat fee to process the charity care application……….. “Honey, make sure to pick up a loaf of bread and while you are it, get our charity care application submitted. We should get back enough to take the entire family to Disney this year.” – Doug Aldeen
!If you’re getting ready to turn 65 but you’re on your spouse’s health insurance because he or she is still working, should you stay on his employer healthcare plan or get on Medicare?
Brokers/Consultants, pay particular attention to the last 2 minutes of this 13 minute video by Eric Bricker. He is absolutely dead on. Too many brokers don’t do this. Instead they waste time working through the Department of No (Human Resources).
The 12/18 contract is over ending 31 December 2023. What are the underwriting losses? No one’s talking, the stop loss brokerage community is tight lipped. Rumors abound lawsuits are flying, attorneys are busy. Who knows the truth? No one is talking.
The attached graph, sourced from the Bureau of Labor Statistics, reveals a worrying trend that should be a wake-up call for all plan sponsors. Between January 2000 and December 2023, hospital services experienced a staggering 243.7% increase in prices, significantly outstripping the overall inflation rate of 82.4% during the same period. This isn’t just an anomaly – it’s a red flag.
A ghost policy is a minimum premium workers’ comp policy for a one-person business. However, the company owner is exempt from the policy, so it doesn’t actually cover anyone. You can expect an annual premium between $1,000 and $2,000.
I’ve seen this first hand years ago when I worked for a large health insurance company. A toxic little man with a big ego and a drive to get to the top over dead bodies drove away the best producers leaving only sedated order takers to make quota. Before their mediocre performance became overwhelming evident to upper management Little Napoleon moved on to another company securing a position of even greater responsibility and authority. He repeated the process, going from company to company until he could go no further as President of a BUCA. – Bill Rusteb
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.”