Listen Now!

Business Talk 24-7

Health Insurance Mergers

Medical Association of Georgia

Donald Palmisano Jr.

Medical Association of Georgia

Dr. John Rogers of Coliseum Northside Hospital

Health Insurance Mergers

On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce amount of competition in the space for Georgians to choose from.

Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations.

MAG believes the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.

The new Aetna (58 percent) and Anthem (30 percent) entities would control nearly 90 percent of the individual market in Georgia. In the small group market, Aetna would control more than 49 percent, while Anthem would control more than 33 percent. Each new company would control about 26 percent of the Medicare Title XVIII marketplace. And for large group market, Aetna would control more than 12 percent while Anthem would control nearly 55 percent.

Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates – which are imposing take-it-or-leave it agreements and unilateral, mid-term amendments with growing impunity.

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state and limit the accessibility of care and individual patient choice.

Georgia Department of Insurance has expressed concerns that the Aetna/Humana merger would violate Georgia’s standards for competition. Specifically, DOI has shared that the Aetna/Humana merger may violate Georgia’s competitive standard in the individual, small group, and Medicare Title XVIII markets while raising concerns of substantially reduced competition in the large group market.

More than 30 percent of the physicians in Georgia who participated in a survey that MAG conducted in the last several months said that they believe that the Aetna/Humana merger would threaten the long-term viability of their practice.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

Dr. John Rogers, Co-Medical Director, Coliseum Northside Hospital

Coliseum Northside Hospital

  • Member, Board of Directors, Bibb County Medical Society
  • Vice President, American College of Emergency Physicians
  • Doctor of Medicine, University of Iowa Carver College of Medicine
  • Residency, Medical Center of Central Georgia

Self Funded Insurance Plans

My Professional CFO

Alan Conner talks self funded insurance plans with CW Hall

Self Funded Insurance Plans

On this week’s episode I sat down with Alan Conner, of Your Professional CFO.  Alan is a tax and accounting expert who works with a wide range of companies and professionals, including physicians.

I met Alan a few weeks ago in the hall of our office building.  After learning about how he helps physicians, I knew we needed to have him stop by to talk about it.  In addition to providing basic accounting/payroll functions, Alan also helps physicians develop effective, legal tax strategies, including self funded insurance plans to reduce their tax burden and risk at the same time.

Alan shared the story of his older brother, an ER physician in Florida.  He explained the fact that his brother, as do many physicians, work as 1099 contractors for the respective practice they serve.  In this relationship, the doctor receives a gross paycheck with no tax withheld.

In this situation it is vital for the provider to plan for their tax obligation and pay it in a timely fashion (at least quarterly) or they face between 5-10% penalties, which can quickly add up to significant amounts, based on the numbers they’re working with.

Alan explained several options available to physicians that work as 1099 contractors, including self funded insurance plans, pension plans, SEP IRA’s, and others, that will help them preserve their hard-earned revenue for later while protecting them from risk such as loss of medical license should that occur.

It’s clear after speaking with him that it is advisable for our colleagues in the community to partner with experts such as Alan to develop a solid plan for managing their tax obligations as well as helping to secure their financial future.

Special Guest:

Alan Conner, CEO, My Professional CFO  twitter_logo_small-e1403698475314  facebook_logo_small3

My Professional CFO

  • MBA, Finance, Nova Southeastern University
  • Previous Investment Banker, Orosey & Pepe Capital Markets
  • Former Investment Manager, Arduus Asset Management