by Admin. | Oct 19, 2009 | Uncategorized
This NY Times Op-Ed by David Brooks is what I mean by when discussing healthcare we need to discuss together the troika – healthcare, tort reform and military spending. Each one represents an incredible beaurocracy and big business with only the strong willed ready to tackle.
We think it’s still 1950s Americana and we can have it all. The very reason Europe can afford rich social, health and educational program is because we are de fatco their military protectors. Imaginge the kind of healthcare we can afford if suddenly 20% were freed up?
by wpengine | Apr 27, 2009 | Uncategorized
Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!
by Admin. | Jan 16, 2009 | Uncategorized
UnitedHealth announces class-action settlement.
The New York Times (1/16, B3, Abelson) reports, “The insurance giant UnitedHealth Group said Thursday that it had reached a $350 million deal to settle class-action lawsuits claiming it had underpaid patients and doctors.” The agreement resolves three suits against the insurer. The proposed settlement, however, is being contested by “one of the lawyers for the plaintiffs” who “says the money is not enough and has filed an objection with one of the judges overseeing the cases.” Nevertheless, the company stated that it is “confident the agreement will be approved by the court.” The company’s announcement comes two days after UnitedHealth “settled allegations from New York Attorney General Andrew Cuomo by paying $50 million and transferring to a nonprofit group its database that set the amount to be reimbursed when patients used doctors outside their network,” Bloomberg News (1/16, Goldstein, Freifeld) adds. UnitedHealth’s Ingenix subsidiary “maintains the out-of-network fee database to determine the ‘usual and customary’ fees.” The database is used by “hundreds of insurers,” according to UnitedHealth. Cuomo claimed that these insurers “used Ingenix’s ‘defective and manipulated’ database to set artificially low reimbursement rates.” The class-action suit against UnitedHealth “alleged that insurers lowered the data they contributed, which then helped them lower their payment obligations,” the AP (1/16, Murphy) notes. As a result, “doctors or other providers often billed patients for the difference.” According to the Chicago Tribune (1/16, Japsen), UnitedHealth stated that its agreement “contains no admission of wrongdoing.” The money is expected to “fund a settlement with health plan members and providers in connection with claims dating back to 1994.” In addition, Thursday’s agreement may “lead to settlements from other insurers” that used Ingenix as well. Minnesota’s Star Tribune (1/16, Yee) and the Minneapolis/St. Paul Business Journal (1/15, Stevens) also covered the story. Aetna agrees to $20 million settlement in reimbursement system probe. The AP (1/16) reports, “Health insurer Aetna Inc. said Thursday it will pay $20 million to help set up a database to calculate out-of-network medical payments in an effort to end a dispute with UnitedHealth Group Inc. over a system that allegedly passed more costs to plan members.” Working with the office of New York Attorney General Andrew Cuomo, Aetna is expected to “set up an independent public database,” as well as “a system to help plan members find out what they will have to pay out of pocket before they visit a doctor who is not part of Aetna’s network,” under the agreement. Earlier this week, Cuomo announced that UnitedHealth had agreed “to shut the database operated by its Ingenix subsidiary, which insurers use to help determine ‘reasonable and customary’ costs for claims for out-of-network physicians,” Bloomberg News (1/15, Freifeld, Goldstein) added. After conducting “an industrywide probe of out-of-network claims,” Cuomo determined that “the Ingenix database was rigged.” He contended that the “corrupted reimbursement system…took hundreds of millions of dollars from the pockets of patients nationwide.” Under UnitedHealth’s settlement, the insurer will “pay $50 million to fund a nonprofit entity to provide independent data on costs.” Dow Jones Newswires (1/16, Bray) also covers the story.
by Admin. | May 20, 2008 | Uncategorized
Greetings!
We are pleased to announce our 10th year anniversary this past March. Back in 1998, the average HMO was only $325/month with office copays at only $10. Then again, gas prices were $2.50, there was Monicagate saga, Google was just a neophyte startup, the Y2K looming as the world’s demise, Seinfeld was still funny, and the US dollar dominated.
At the time, I was working out of my home office wondering will I get a client before my unemployment checks run out? I was short on time and money for creating a web presence, organizing a marketing plan and seeking outside lending. I was way in over my head as they say.
Healthcare was volatile at the time with carriers shifting the costs burden onto businesses. I suppose nothing has changed in 10 years with the exception of less companies vying for our business as consolidation was abound. Since that time, Aetna bought U.S. healthcare which bought NYL Care and PruCare. Oxford almost went out of business, their stock dropping from $86 to $6 in a matter of weeks. Five years later United Healthcare bought out Oxford. Empire survived 9/11 but was bought by WellPoint 2 years later. The Blue Crosses stopped competing against each other with Horizon Blue Cross dropping out of NY and Empire leaving NJ.
At the same time, new players have entered the industry. Healthpass has become a great way for small businesses to offer multiple plan options and carriers and compete with larger corporations. Atlantis Health Plans has become a medical inflation controller with rates still below $300/month. There was no Healthy NY to offer state supplemented corporate plans. The online functionalities has also evened the playing field for small businesses by keeping costs down, reaching the end users quickly and carving market niches.
By being a small business ourselves, this experience has made us more in tune and sensitive to our client needs. We are batting virtually 100% with claim and billing disputes and help employers maximize their benefits while discovering market inefficiencies. Borrowing from Google’s creed, “don’t be evil”, has helped us grow to over 300 employer groups and over 3500 members strong.
We are proud of our achievements and have been awarded the industry’s 2008 NAHU Golden Eagle Award for outstanding sales & achievement. Last summer’s move to Armonk, NY has allowed us to merge with a long time Property & Casualty brokerage firm, Avanti Associates. This will give our clients competitive markets for building, auto, malpractice insurance, professional liability and workman’s comp that they may not have had.
What’s next? We are ramping up an HR Kiosk service from the existing “physician locator” and “forms warehouse” links on our website. Many of you have already been using these tools when shopping for the annual plan renewals. But what about offering an intranet like kiosk where your employees can view, for example, their Aetna medical and Oxford dental plans from on one site? Or having the ability to post HR policies on vacation days, COBRA information or 401k documents?
We’ve enjoyed our experience and learned a lot from challenges faced but we really learn the most from our clients at the end of the day. You are the reason we have been fortunate to be in business and we depend on your suggestions and referrals to sustain our business model. We offer many extra’s and help you stretch your healthcare dollars as a way of thanking you and hope to continue to grow as a valuable part of your business.
Finally, I want to congratulate my brother Jonathan on his recent marriage this past Valentine’s Day. Also, he has dedicated 5 years at MMS, Inc. and I owe him a world of gratitude for realizing many of the goals of the firm. He has distinguished himself from a young college grad to a marketing and accounts manager who runs everything from renewal proposals to managing the day to day nuts and bolts that makes the agency work.
Sincerely,
Alex Miller
by Admin. | Mar 25, 2008 | Uncategorized
Today, march 25th, 2008 I will start a blog. Blogging has fascinated me as a way of sharing ideas with people. Unlike my website, I can quickly share topical points of interest, highlight links, and info on the local NY Healthcare market. In today’s age, I can’t imagine 2 more compelling topics than Gotham and Healthcare.
One day I stumbled upon http://www.techcrunch.com/, and immediately thought that I would enjoy creating my own healthcare blog.
My opinions are my own. I hope that I make readers think. I look forward to interacting with readers and seeing their perspectives. I have always learned more from clients in my line of work than any other source especially from physician groups.
Thanks for visiting my personal place to rant and pontificate.
