Monday, November 4, 2024

One Mom’s Nose for Savings

Exorbitant Hospital Pricing in the U.S. Undermines Morale, Employee Compensation, and Employer Profits — It Must Stop

As the sun dipped below the horizon on a brisk spring evening, a young mother crouched behind home plate, catching for her daughter.  Already showing signs of a future softball superstar, Gisele unleashed a wicked rising fastball.  It clipped the edge of the glove and smashed into her mother’s face, cracking bone and pushing her nose sharply to the left. 

In a display of savage tenacity, Mom wiped the blood away, grimly reset her nose with a crackling snap, and resumed her catching duties for the evening.  Despite her efforts, the misshapen lump and the nose’s noticeable leftward slant gave her the hardened appearance of a seasoned mob enforcer.

Doctors told her she’d almost certainly require surgery but wanted to let the swelling subside and see how her breathing progressed before they intervened. 

Months later, she couldn’t breathe through her left nostril; she wanted her beak fixed. Luckily, she found herself on a Mahoney Group plan backed with Reference-Based Pricing and Cash-Pay options at recognized centers of excellence.

  • So no, UHC and Adventist, her plan isn’t going to pay $74,000. 
  • Nor will she pay the $58,000 sought by Cigna and El Camino Hospital. 
  • Not going to pay $73,000 either, Western Health and John Muir. 
  • And we say nay nay to the $73,000 Santa Rosa Memorial wants from EVERY commercial payer.  (Hat tip to the late, great John Pinette.)
  • She’ll pass on the $51,000 Stanford and Blue Shield want.
  • And UCSF and Aetna can only dream about that $69,000 they lustily crave.  

At 140% of Medicare, we will pay $7,811 for this surgery.  If circumstances such as geography, timing, or specialized surgeons demand a higher price, we can negotiate.  But that is seldom required.  In this case, Gisele’s Mom is getting her nose fixed up for a voluntary cash price of $7,750. 

Plus, since Mom agreed to use the cash-steerage option, her employer is paying 100% of the cost of the procedure and waving all deductibles and coinsurance

And from now on, Mom’s going to wear a catcher’s mask. 

Monday, October 28, 2024

The 5 Forces of Justice - 5 Different Forms of RBP

This ain't yo grandpappy's RBP!  Five different ways employers are installing RBP to save millions on healthcare costs.


Tuesday, October 1, 2024

Wednesday, July 24, 2024

Monday, June 24, 2024

How to Become an HR Superhero

With over 15 years of teaching benefits and human resources at the university level, coupled with exclusive experience in working alongside C-Suite executives to implement and manage highly efficient benefit plans, I have a crucial piece of advice for any HR professional looking to be seen, appreciated, and impactful in their career.

 

Thursday, June 6, 2024

Employers & Employees: Stop Buying So Much Insurance!

The insurance industry is massive, powerful, and 100% designed to win every single time. Commissions on some items you buy are more than 50%. YOU DON'T NEED ALL OF THAT!

Tuesday, June 4, 2024

Bad Drugs - Pharmacy Prices Are Killing Employers

Rx Costs have increased 500% since 2000; kickbacks now account for one-third of all spending on pharmaceuticals. What is an employer to do?

  

Monday, June 3, 2024

Surround Yourself with Your Weakness

 To give yourself the best opportunity for career success, surround yourself with your weakness.


Sunday, May 12, 2024

How Do You Pay Your Reference-Based Repricer?

When engaging in Reference-Based Pricing on your employer health plan, there are several different ways you can pay that repricer: per employee per month, a percentage of billed charges, a percentage of savings, or a flat fee. Which one or ones are best, and why?


Wednesday, May 8, 2024

Fleecing Employers - Health Insurer Overrides

What are health insurer overrides?  What do they mean for employers and employees?  How do you know where they are most likely to lurk?  

I've uncovered a new nugget of insider intel on this one - insurance brokerages are turning the volume up to 11 on their insatiable longing for these hidden payments.