Right is right, wrong is wrong!
Watch John’s no holds barred approach to solving healthcare problems.
Right is right, wrong is wrong!
Watch John’s no holds barred approach to solving healthcare problems.
TPA Preferred Vendors - WASTE! Buy Your Employees a $5 Footlong!
Our Member Champion Role = Winning For Employers
Lilly and Optum are Stealing
from Our Communities (Insulin)
Employers Paying to Get
TPA's Are Paying
Just Say No to paid
Title's and ego's
John Harvey, co-founder of Wincline. Today, I'm fired up about job titles and egos, let me tell you why.
Titles in our industry have become marketing tools and ego inflators, right is right, wrong is wrong. Employee benefit brokers, they represent the buyer and the seller, meaning the employer and the insurance company. And they work off a percent of premium commissions. Should be illegal. Matter of fact, it is illegal in most industries, right is right, wrong is wrong.
Conflict of Interest.
Consultant. This is interesting one, they don't know why they're a consultant. See, broker, they act in the same capacity as a broker, they're having an identity crisis, right is right, wrong is wrong.
The most important one up here is advisor. To be an advisor. You have to be an independent fee-only, not fee-based, fee-only you get paid by the employer, your clients. What this allows is the mediate conflicts ultimately avoiding that instead of misalignment. And what that means is you get to advise with your client’s best interest in mind.
At the end the day What that means is you lower health care costs and increase the benefits. Right is right wrong is wrong.
If for some reason your costs aren't going down. You're not improving benefits. You may want to check if you're working with a broker or a consultant.
To learn more, please visit Wincline.com.
John Harvey, CEO/Founder of Wincline. Today, I'm fired up because Direct Contracting has unfortunately become a buzzword.
Look, we need direct contracting in our industry. We need it done the right way. Many vendors, brokers, TPAs are creating a less bad PPO solution.
What that means, you need a neat procedure. They're taking facility, physician, anesthesiologist costs, bundling up and saying, "Hey, only thing I can "guarantee you, it's gonna be less "than a PPO network discount."
Doesn't make it fair, doesn't make it right. There is no clear, upfront contracts. Right is right, wrong is wrong.
The right way of direct contracting is solely between the employer and the physician. Hence, direct contracting. Right is right, wrong is wrong.
At the end of the day, the provider establishes the price based on value. The employer can determine if they wanna purchase that service or good. Right is right, wrong is wrong.
Check out our website to learn more. Thank you.
to Medical Coupons!
Smoke and Mirrors | Are You Paying to get Ripped off?
TPA Admin Credits vs. Rx Rebates
Which is Better?
Are Where It's At!
Stop Outsourcing Your Job...
Conflicts of Interest
John Harvey, CEO Founder of Wincline. Today I'm fired up about recklessness, fraud, and conflicts of interest in group health care plans. Right is right, wrong is wrong.
Listen, there's no secret sauce in lowering health care costs. The way we do that, reduce the number of claims. Another way, reduce the severity of claims.
How do we do that? We get people out of the hospital. Have them do elective surgeries at ambulatory surgery centers. Common sense there. Right is right, wrong is wrong.
The problem we're seeing today is these ambulatory surgery centers are owned by revenue generating service companies. Conflict of interest. Right is right, wrong is wrong.
Furthermore, we're seeing TPAs that are paying these billed charges at 100%. Often a thousand times Medicare. Right is right, wrong is wrong. Number three. 99% of these plans are incurring these charges and paying them at a reckless amount. Right is right, wrong is wrong.
Get an advisor that knows what they're looking for, that can mitigate your risk. Check out our website for more information. Thank you.
Primary Care is
Vital for RBP!
John Harvey, CEO/Founder of Wincline. Today, I'm fired up because Primary Care is vital.
It's vital to healthcare and it's vital to reference based pricing.
Had a client call me yesterday, tell me about an employer in Arizona that's doing reference based pricing.
Come to find out, that employer is using a physician-only network. Leasing a network, that is not right.
We need to pay physicians more. After a BUCA carrier network, reimbursement for physicians are 98% Medicare. That's not enough. We pay hospitals, facilities, 250 to 400 percent of Medicare.
The solution, implement a true, open reference based pricing plan. Pay physicians more. You have to offer better benefits to lower healthcare costs and primary care physicians, doctors are the answer.
Number three, they are boots on the ground. These are the individuals frontline that are directing care, that are taking care of you, your spouse, your children, taking care of your community. They deserve more.
Do the right thing. Right is right, wrong is wrong. In conclusion, if you wanna find out more information, give us a call.
is at risk!
John Harvey, CEO and founder of Wincline. Today I'm fired up because your community is at risk. Right is right, wrong is wrong.
Today we me met with an employer. Happens to a be a local non-profit organization. Their broker one of the largest, oldest publicly traded brokerage firms in the U.S.
Currently this local non-profit organization is partially self-funded meaning they have stop loss in place. The broker, the publicly traded broker works off a percent of commission on that stop loss.
Come to find out they have one of the lowest spec individual stop loss deductibles I've ever seen because of a percent of commissions. Right is right, wrong is wrong.
What we learned today is the publicly traded broker recommended last renewal and still recommends that this local non-profit organization move to fully insured. Why? Right is right, wrong is wrong.
We know fully insured is legislatively set out to fail. It cannot work as an alternative option to partially self fund. Right is right, wrong is wrong.
Why is it legislatively set to fail? Because of ACA healthcare reform had a mandate medical loss ratio MLR where insurance carriers for every dollar they receive they have to spend either 80 or 85% in claims leaving 15 to 20% margin.
The only way they can increase that margin the publicly traded companies is to raise rates. Legislatively set up to fail. Right is right, wrong is wrong.
We need to look out for our community. We need to look out for employees. Do the right thing. Right is right, wrong is wrong.
If you have any questions reach out to us. Check out our website. We have more information on the MLR and how it's legislatively set up to fail. Right is right, wrong is wrong. Thank you.
What's worse than
Right is right. Wrong is wrong. John Harvey, CEO and Found of Wincline.
Today, I'm fired up because the only thing worse than paying off a network discount is paying full, out-of-network, billed charges.
Let me share with you how we uncover a global issue. Right is right. Wrong is wrong. We have a partially self-funded client. Claim came through for $49,500. Out-of-network bill charges. We reviewed the claim. Medicare price, $724. Not approved.
Right is right, wrong is wrong. This was a second physician in the operating room committing fraud. This is happening in your plan today.
You need an independent TPA and you need an independent fee only advisor.
Call us if you have any questions, thank you.
are you being
Direct Cash Pay Agreements Should be the Norm, not the exception!
It's Time To End Conflicts of Interest Once and For All!
Why the Medicare Rate is Used
As the benchmark for RBP
Nothing Worse than
show your prices!
John Harvey, CEO Founder of Wincline.
Today I'm fired up about Arizona nonprofit hospitals. Look, I love Arizona. I love our community. We have several employers that are based in our community that are taking back control of their healthcare costs. Saying no more to inflated rates, no more to eroding wages.
They have a member that needs a surgery that is utilizing a local, nonprofit hospital that is charging 80% of billed charges. 80% of what? We don't know. Some irrelevant, arbitrary number that you only get when you render services.
These local employers are saying no more to billed charges. Right is right, wrong is wrong. Solution, thank you doctor Smith. Surgery Center of Oklahoma published prices on their website.
This member is now going to Oklahoma to have this surgery, have a quality surgery at a fair price. Right is right, wrong is wrong. Learn more, check out our website.
reference based pricing
John Harvey, CEO and founder of Wincline. Today, I'm fired up about a step to achieve a greater purpose, reference based pricing.
We are trail blazing this in Arizona. Employers need to know what this is. Ask 10 different people what it is, you'll get 10 different answers. You wanna know what reference based pricing is? We're doing it, full reference based pricing.
We need to do it because it's the right thing to do. Right is right, wrong is wrong. A few things. What it achieves, reduces claims costs. No longer purchasing healthcare off a made-up bill-charged number. Right is right, wrong is wrong.
Number two, free choice. Just like everything else we buy in this society, we have the option to render care where we want, how we want, when we want.
Number three, puts employers in control of one of their largest line items. Stop taking away from wages. Let's control that largest line item and invest in our people. Right is right, wrong is wrong.
In conclusion, reference based pricing is a step to achieve a greater purpose. You need to know what it is. You need to know what it is not. Check out our website, www.wincline.com.
Check out our articles to learn more. Thank you. Right is right, wrong is wrong.
top 5 things i'm fired up
for in 2019!
John Harvey, CEO and founder of Wincline. Here are my top five things I'm fired up about in 2019. Happy New Year. Right is right, wrong is wrong.
Number five, provider roadblocks. We have many employers that purchase healthcare direct, they do not use a network. We often hear from members, well they don't accept our plan. Yes, they do. Providers, please be part of the solution, not the problem, providers, you take the plan.
If you have a medical license, and you can accept payment for a fair reimbursement. Right is right, wrong is wrong.
Number four, Charge Master Scam, CMS. Speaking of CMS, they recently came out with their 2019 transparent pricing rule. Medicare and transparent pricing exist today. Transparent pricing and commercial insurance does not exist today. Transparent pricing and hospitals does not exist today. Why, because of the Charge Master Scam. We now need to get rid of the charge master, establish fair and reasonable rates, and publish them for all. Right is right, wrong is wrong.
Number three, healthcare equals bill, should be price. Today we render services, have no idea what the cost is, get a surprise bill later. Healthcare needs to equal price. How much is the cost of services going to be for future rendered services. We need to get rid of the current billing system, and establish fair reimbursement prices for all. Right is right, wrong is wrong.
Number two, healthcare two point 0. There's never been a more exciting time to be in healthcare, healthcare is reinventing itself every single day, because the status quo is no longer acceptable. Consumers are asking questions, why does it cost less when I don't have insurance. Employers are asking questions, status quo is no longer acceptable, and there's never been a more exciting time to be in healthcare. Right is right, wrong is wrong.
And, the number one reason I'm fired up in 2019 is bye, bye brokers. Traditional employee benefit brokers will become irrelevant, working off a percent of commission is not the right thing to do. Employers need to hire an independent, fee only, advisory firm. Right is right, wrong is wrong.
Thanks for listening, top five things I'm fired up about. Right is right, wrong is wrong. Want to find out more information about this, check out our latest blog on Wincline.com. Thank you.
why do you care?
not your money.
John Harvey, CEO and Founder of Wincline. Today, I'm fired up about, "Why do you care, it's not your money?" Right is right, wrong is wrong.
Recently, we have a client that is partially self-funded through a B.U.C.A.H. carrier where we saw a $1.6 million claim come through as medical. Come to find out, 1.5 million was paid in three simple payments of $500,000 via RXJcode.
Note, although free shipping, no money back guarantee here. Right is right, wrong is wrong.
We reached out to a specialty pharmacy. Direct cost of this drug, $200,000. Right is right, wrong is wrong.
Proceeded to have a meeting with the executive team, medical director of this carrier. First thing they ask, "Why do you care, it's not your money?" Right is right, wrong is wrong.
MRIs, as we know, all have prior authorization. We wanna get one done. Can we not have one done on a $1.5 million drug? Right is right, wrong is wrong.
If you have any questions, give us a call. Thank you.
Always do the
John Harvey, CEO/Founder of Wincline. Today I'm fired up about doing the right thing. Right is right, wrong is wrong.
Let me give you an example. We have a large self funded client with a BUCA carrier. This plan has no out of network benefits.
Recently, we were reviewing their claims and noticed a $16,000 admin charge that didn't seem right. We asked them about it. They told us a $50,000 out of network claim was submitted and they didn't want the member to be bounce billed.
So, they took the liberty to negotiate that to $1800 and run it through as an in network claim. This should not be allowed, it's not allowed. Right is right, wrong is wrong.
And since they did such a great job, they paid themselves $16,000 for doing so. Right is right, wrong is wrong.
Not allowed. Let me give you an example. You get your AMEX. $50,000 charge on there. You call em up, what is this? I never spent $50,000. They said there's a charge through the Netherlands. Never was in the Netherlands. They tell you, "Hey, but we can negotiate it down to $1,800, "but we paid ourselves $16,000 service charge for doing so." This would never happen. There's checks and balances. Right is right, wrong is wrong.
We are your checks and balances for healthcare. Give us a call if you have any questions.