Texas Region Biotech Networks’ Post

Private health insurance serves no beneficial purpose. It neither controls costs nor expands coverage, and it certainly doesn't expedite care—in fact, it hinders all three. It profits by inserting itself as a rent-seeking middleman between patients and providers, adding unnecessary costs to healthcare. Simply look at the PBM (pharmacy benefit manager) business model and ask yourself what value it delivers. Since 2010, profits of the top health usurers were a collective $371 billion, of which $120 billion was distributed to their shareholders. Meanwhile, half of US adults say they cannot afford an unexpected $500 medical expense.

Participating Providers: Bridging the Gap Healthcare institutions and practitioners who have contracted with health insurance companies are known as participating providers, or “in-network” providers. The terms and conditions for offering medical services to policyholders who are part of that specific insurance network are outlined in these agreements. These contracts cover a wide range of topics, such as costs, rates of reimbursement, and the scope of services to be rendered. Non-Participating Providers: Outside the Network Non-participating providers, sometimes referred to as “out-of-network” providers, do not have formal contracts with any particular insurance network, in contrast to participating providers. Rather, they are autonomous entities that set their own prices for healthcare services. #Healthcare #Providers #MedicalBilling #Credentialling #Contracting #RCM #Participating #NonParticipating

Today marks the beginning of an exciting journey as an innovative cost reduction program is offered that can service companies with over 300 enrollees. With this innovative solution, not only can healthcare costs be made predictable, but they can also be reduced over time, all while providing an exceptional member experience infused with cutting-edge technology and optimal payment practices. This program tackles the excess costs and conflicts of interest often associated with conventional health insurance plans, prioritizing what truly matters. Through the comprehensive platform, which seamlessly integrates medical claims administration, pharmacy benefits, preferred contracting, and member support, the strategy streamlines operations and optimizes efficiencies. These savings are typically beyond reach with legacy health insurance plans, enabling employers to furnish superior benefits at reduced costs, thereby bolstering their capacity to attract and retain top talent in a fiercely competitive market. For further details and to arrange a consultation, please visit our website at https://lnkd.in/dTCWFT5J . #InsuranceSavings #CostReduction #InsuranceBudgeting #PolicySavings #PremiumReduction #CuttingInsuranceCosts #FinancialWellness #CuttingCosts #SavvyInsuranceSolutions #Wellnesssolutions #preventativecare #proactiveculture #employeewellness #prescriptiondrugcostsavings

Do you know the 5 factors that determine healthcare premiums? By law, healthcare insurance can only use these 5 factors in determining costs. Read more on our blog: https://bit.ly/3HJ0nul #HealthcarePremiums #HealthInsurance #AUI

In medical billing we are processing for submitting and managing claims with health insurance companies to receive payments for services provided in health care sector. We feed medical details into healthcare providers system. It is essential for the financial and healthcare providers to ensure the provided services is proper and billed.

We know that shifting to value-based care — health plan payment models that reward good patient outcomes — is difficult, requiring seamless data sharing among providers and payers and educating patients about value-based options. Nevertheless, the health insurance industry is making it a priority because it leads to better patient outcomes and lower costs for everyone. AJMC - The American Journal of Managed Care outlines a recent discussion at the fall conference of the National Association of Accountable Care Organizations: https://lnkd.in/esRyFNxH

#DailyDoseofDelahoussaye What is a Pharmacy Benefit Manager? Ever wondered about the role of Pharmacy Benefit Managers (PBMs) in our healthcare system? PBMs play a vital role in ensuring smooth operations within our healthcare system. They manage prescription drug benefits for health insurance plans, playing a key role in controlling costs and improving outcomes. #healthcare #pbm #humanresources #commercialinsurance #hubinternational

GoHealth (NASDAQ: GOCO), a leading health insurance marketplace and Medicare-focused digital health company, today announced financial results for the three and nine months ended September 30, 2024. “Our third-quarter results underscore the strength of our ongoing transformation into a Medicare engagement company. We’ve helped over 650,000 consumers navigate Medicare options through tools like PlanFit CheckUp, and with the addition of e-TeleQuote’s 400 agents, we’re prepared to efficiently serve the demand surge we are seeing in this year’s Medicare Annual Enrollment Period. We believe these developments reinforce GoHealth’s leadership in the eBroker space, positioning us for sustained growth and profitability,” said Vijay Kotte, CEO of GoHealth. For more third-quarter highlights and GoHealth's strategic positioning for AEP 2024, read our latest press release: https://lnkd.in/g9Qz3U9r A live audio webcast is also available on our Investor Relations website: https://lnkd.in/gwWPAVKT

Today marks the beginning of an exciting journey as an innovative cost reduction program is offered that can service companies with over 300 enrollees. With this innovative solution, not only can healthcare costs be made predictable, but they can also be reduced over time, all while providing an exceptional member experience infused with cutting-edge technology and optimal payment practices. This program tackles the excess costs and conflicts of interest often associated with conventional health insurance plans, prioritizing what truly matters. Through the comprehensive platform, which seamlessly integrates medical claims administration, pharmacy benefits, preferred contracting, and member support, the strategy streamlines operations and optimizes efficiencies. These savings are typically beyond reach with legacy health insurance plans, enabling employers to furnish superior benefits at reduced costs, thereby bolstering their capacity to attract and retain top talent in a fiercely competitive market. For further details and to arrange a consultation, please visit our website at https://lnkd.in/dTCWFT5J . #InsuranceSavings #CostReduction #InsuranceBudgeting #PolicySavings #PremiumReduction #CuttingInsuranceCosts #FinancialWellness #CuttingCosts #SavvyInsuranceSolutions #Wellnesssolutions #preventativecare #proactiveculture #employeewellness #prescriptiondrugcostsavings

Today marks the beginning of an exciting journey as an innovative cost reduction program is offered that can service companies with over 300 enrollees. With this innovative solution, not only can healthcare costs be made predictable, but they can also be reduced over time, all while providing an exceptional member experience infused with cutting-edge technology and optimal payment practices. This program tackles the excess costs and conflicts of interest often associated with conventional health insurance plans, prioritizing what truly matters. Through the comprehensive platform, which seamlessly integrates medical claims administration, pharmacy benefits, preferred contracting, and member support, the strategy streamlines operations and optimizes efficiencies. These savings are typically beyond reach with legacy health insurance plans, enabling employers to furnish superior benefits at reduced costs, thereby bolstering their capacity to attract and retain top talent in a fiercely competitive market. For further details and to arrange a consultation, please visit our website at https://lnkd.in/dTCWFT5J . #InsuranceSavings #CostReduction #InsuranceBudgeting #PolicySavings #PremiumReduction #CuttingInsuranceCosts #FinancialWellness #CuttingCosts #SavvyInsuranceSolutions #Wellnesssolutions #preventativecare #proactiveculture #employeewellness #prescriptiondrugcostsavings