Risk Managers – Thought Leadership on Health Insurance

Willacy County Employee Health & Welfare Plan Adopts Wellness Initiative

FOR IMMEDIATE RELEASE

Willacy County Employee Health & Welfare Plan Adopts Wellness Initiative

Raymondville, TX – April 15, 2024 – Willacy County is pleased to announce the launch of its latest initiative aimed at enhancing the health and wellness of its employees. The new program is designed to promote healthier lifestyles and improve overall well-being among county employees.

Government Encourages Hospitals To Raise Prices & Buy Physician Practices

CMS Invites Hospitals To Raise Prices And Buy Physician Practices

By Ge Bai – Contributor

Mounting hospital bills, crushing medical debt, ballooning insurance premiums… While we are wrestling with these widespread healthcare affordability problems, it’s helpful to keep in mind that they are often caused by public policies. The most recent example is the financing scheme of Medicaid expansion in North Carolina.

More Lloyds of London History by Miller

By Paul Miller

Bollywood stars Sunny Deol and Amitabh Bachchan have both taken out insurance on their voices.

The Importance of Dental Care Coverage Is Often Overlooked By Health Plans

Joe Sixpack, a young man, has bleeding gums. He has no dental coverage and can’t afford to see a dentist. Besides, who on God’s earth wants to see a dentist anyway? So Joe ignores his symptoms.

Need Professional Liability Cover?

Insurance Agents, Lawyers, Real Estate Agents and more. Admitted and non-admitted. Instant quotes

BUCA Owned TPA Tacitly Admits Not All PPO Providers Enjoy The Same Managed Care Contract

“We have the best discounts!” says the BUCA owned TPA rep. “Just ask any of our providers and you’ll see its true!”

Give Me Some Sugar!

Research shows that diets high in added sugar increase heart disease risk factors such as high triglycerides, elevated blood sugar and blood pressure, obesity, and atherosclerosis—the narrowing of arteries caused by fatty deposits accumulating along artery walls.

If Air Travel Worked Like Healthcare

Cynthia helps Jonathan through the complicated maze of the American airline system.

We Won’t Accept 120% of Medicare, But We’ll Accept 89%!

We received an email today from 6 Degrees. The graph above caught our attention.

TEXAS Limits Ground Ambulance to 325% of Medicare & Promulgates Other Neat Things

The Texas 88th Legislature passed a slurry of bills affecting group insurance plans. Below are a few of them:

Direct Primary Care Is Too Expensive!

“Direct primary care is too expensive!, It’s two, three, four times more expensive than fee-for-service primary care!” cries the insurance consultant waiving his calculator. “The true cost should be something south of a $20 membership, not $70, $80 or more!”

I Fired My Doctor Last Week

By Sims Tillrson

I fired my doctor last week after seeing him for over 5 years. He didn’t do anything wrong – the system did.

Aldeen’s Sunday Morning Bathroom Read

“Your honor, the facility has already been paid TWICE- perhaps even more than its billed charges.”

New Evidence-Based Healthcare Pricing Standard Available for Paying Out-of-Network Medical Claims

MyHealthGuide Source: Denniston Data Inc, The Healthcare Transparency Company, 4/10/2024

The U.S. healthcare marketplace needs a transparent standard that is fair to patients, providers, and self-insured employers offering health benefits to their employees.

AUSTIN, TX — In its Healthcare Pricing Guide (HPG) solution, Denniston Data Inc. (DDI) offers standardized benchmark rates by procedure code inclusive of all in-network negotiated rates for every medical service performed by every provider, from every health insurance company. These agreed-on negotiated marketplace rates can be used as the basis for fair compensation for out-of-network providers.

RBP Pure Medicare Methodology Is Flawed

WellRithms Publishes White Paper Exposing Flaws in Reference-Based Pricing and Introduces Superior Alternative

“While RBP allows employers more than one way to pay a medical bill without having to establish a provider network, thereby opening the marketplace, it has still failed to provide a methodology that is transparent and understandable. RBP’s pure Medicare multiple is arbitrary and does not meet the definition of UCR pricing.”

Stop Loss Carrier With Bells On Their Balls Offers Participating Contract

How do you know if your stop loss carrier has bells on their balls? And what’s the implication if they do or don’t? Glad you asked………..

We just learned of a stop loss carrier that guarantees, for a premium load of 6%, a 30% premium refund if spec. claims are below 50%.

Participating stop loss contracts are not new although few brokers and plan sponsors are aware they exist.

Mike Keogh

“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

By Bill Rusteberg

Mike Keogh was an extraordinary man. A former Blue Cross salesman in the 1950’s, he later built an independent brokerage in San Antonio with great success. I met Mike in the early 80’s and did quite a bit of business with him.

Insomnia?

Having trouble sleeping? Here’s a solution for you!

Newborn Dies After Local Hospital Refuses Care

She rushed to the hospital when her water suddenly broke, but returned home as she was unable to pay what the hospital charged for the operation. In the end, the baby died during delivery at home, and the mother became critically ill.

Another Government Health Insurance Ruling Issued Because You’re Stupid & Can’t Read

“We had to issue this new ruling because Americans can’t read!” explained the high ranking government official during Happy Hour at the Off The Record watering hole.

“But if that’s true, how do you expect them to read the new rule?” replied the bartender.

We’re Ok Because Everyone Else Is Not OK Too (There’s Plan C Just In Case)

“The Butler didn’t do it! But maybe he can fix it. Call him in NOW!” Sherlock Holmes says to Watson. “You mean Josh? Josh Butler?” replies Watson

Your Plan Compared To Our Plan

This is your plan. Your costs increase every year. Ours don’t. That’s curious isn’t it?

More Lloyds of London History By Miller

By Paul Miller

The picture above shows one of four Lloyd’s Medal types bestowed by Lloyd’s of London.

In 1939, Lloyd’s set up a committee to find means of honouring seafarers who performed acts of exceptional courage at sea. This resulted in the announcement on 27 December 1940 of the “Lloyd’s War Medal for Bravery at Sea”.

Happy Eclipse Day!

SHADOW PRICING: Marketing’s Preferred Approach To Underwriting

Proper rate setting must be based on one’s own risk not based on someone else’s. That’s simple common sense. To do otherwise is a recipe for disaster.

Plan Sponsors Face Punishment If They Screw Up Their Health Plan

More Risks, More Opportunities for Employers in Healthcare

Heightened legal risks are forcing many employers to reconsider their hands-off approach to purchasing healthcare — delegating the management of plan assets to insurers or third-party administrators owned by insurers.

Patient Accidentally Drinks A Bottle of Invisible Ink…

He’s now at the hospital waiting to be seen……………

More Lloyds of London History by Miller

By Paul Miller

This picture shows Audrey Hepburn receiving treatment after injuring four vertebrae. It was an injury that cost her insurer Fireman’s Fund $240,000.

When Free Market Leadership Fails, Government Steps In

Many Americans look to government for help since a free market in American health care doesn’t exist when it could. When plan sponsors grow balls and take action against the Medical Industrial Complex good things happen. But like anything else in life, leadership only succeeds when followers heed the siren.

A Dutch Rojas Pictorial

How Are Texas School Districts Outside TRS ActiveCare Faring These Days?

The short answer is “Not too good.” Some districts are learning the grass is not always greener on the other side.

Bill Ebaugh

William Lee “Bill” Ebaugh

It’s been six years since Bill’s forced retired at 88 years of age. We wonder what he’s been up to these days…………….

The Great Escape

Health insurance has become a highly regulated government utility complete with punishing government sanctions for those who err. All make mistakes, for to err is human and pervasive. No one is perfect. An attorney’s dream.

A post on Linkedin yesterday reminded all of us how complex compliance issues are plaguing government enslaved employers these days.

Below are 15 reasons why ICHRAs make sense to more and more employers fed up with all the rules and regulations, ready to escape the threat of punishing government sanctions, contingency based lawsuits and time lost to productivity when dealing with the non-sensical and crazy world of American health insurance.

Is The TSHBP Making a Cash Call To Member Districts?

Last year it was reported the TSHBP renewal offer included a provision for a cash call to member districts should funding prove insufficient to pay claims and expenses at any time during the 2023-2024 plan year.

Ozempic’s 18,600% Price Markup

Ozempic production costs less than $5 a month: Study

State Employee Health Plan Ends Weight Loss Drug Coverage

Weight Loss Drug Coverage Ends for North Carolina State Employees

“State officials are continuing to negotiate with makers of weight-loss drugs in an effort to reach a better financial deal that would allow coverage of the drugs through the State Health Plan …

Stealth Startup Eyes Cash Pay Health Plan Opportunities?

Who is behind a Stealth Startup company sniffing around the market sensing Cash Pay Health Plans present investment quality opportunities?

Six Employees Take Home $64,000,000 Of Your Health Insurance Premiums

Elevance Health is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies’ health plans.

Kempton Cash Price Agreement

More employers are realizing cash paid medical claims reduce plan costs 50% and more over “discounted” managed care pricing. More TPAs like Kempton are joining the Cash Pay Health Plan movement with good success.

Insurance Broker Bails Out Trump

Don Hankey owns Knight Insurance Group and is chairman of Knight Specialty Insurance Company, the company that issued the $175 million bond Donald Trump posted in April 2024 to appeal the verdict in a civil fraud case.

TSHBP Cancels Free Food & Gift Card Event – Giftless School Officials Go Hungry

Regional Meetings Cancelled

After promising free food and gift cards to Texas school district officials the TSHB has rescinded the offer.

The Power of Words

Words are the most powerful tool humans have ever had. Mastering language by reading and writing, starting at a young age, will prepare children for success no matter what they end up doing for a living.

President Biden Expands Medicare For All

WASHINGTON – April 1, 2024

With a stroke of his magical pen President Biden’s Executive Order expands Medicare coverage to every living American whether they pay taxes or not.

The Uncured Have A Shorter Shelf Life

SOURCE: The Cured Has Longer Shelf Life

We don’t cure our patients because it’s not necessary. It’s a choice we made to remain faithful to ourselves and you.

The Erosion of Physician Autonomy

“He Who Controls Referrals Wins” – Molly Mulebriar

“Around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system…………..Many physicians say they are losing their ability to influence how patient care is delivered — 60% of physicians said non-physician ownership of practices results in a lower quality of patient care, according to the NORC survey.”

The Reimbursement Conundrum

“The reimbursement battle rages on, a healthcare tug-of-war with patients caught in the middle.”

4,000 Pound Gorilla Sees Value In Direct Primary Care

The trustees of the Hidalgo County self-funded health plan providing healthcare benefits for the county’s +4,000 employees administered by Aetna believes there may be a better solution than traditional fee-for-service primary care.

Marpai Q4 Earning Call Transcript

Get ready for strong earnings……………….

This Week’s Episode of “Can’t Make This Shit Up”

By Preston Alexander

In this week’s episode of can’t make this sh*t up……….

Baltimore Bridge Losses Could Be A Record Shipping Insurance Loss

Insurers could face losses of up to $4 billion after Baltimore bridge tragedy-analyst

By Sinead Cruise, Jonathan Saul and Carolyn Cohn

LONDON (Reuters) -Baltimore’s Francis Scott Key Bridge collapse could cost insurers billions of dollars in claims, analysts say, with one putting it at as much as $4 billion, which would make the tragedy a record shipping insurance loss.

“Three Magic Words”

By Marshall Allen

Laurie Powsner had recently left her full time gig as a social worker, so this year she and her husband got their insurance coverage on the individual market.

Will Grace Ocean/Maersk Rely On Same Law The Titanic Did To Limit Liability?

By Skylar Romines

Could Singapore-based Grace Ocean and shipping giant Maersk look to rely on an obscure law from 1851 to reduce liability for losses caused by container ship Dali crashing into the Francis Scott Key Bridge?

Bernie Demands Danish Company Adopt Canadian Rx Pricing

Bernie Bongo The Economist

Bernie Sanders Calls On Novo Nordisk To Lower Cost Of Ozempic And Wegovy

The White Coat Exodus

By Dutch Rojas

The deal was simple – sacrifice over a decade of your life in school and residency, take on crushing debt, work inhumane hours, and in return, you’d be set for life as a respected physician.

Uh Hmm, You Are Assessed $100,000

Properly managed self-funded risk pools make allowances for unexpected loss either through proper reserving or through contractual obligations of pool members bearing risk.

RBP Shield

Integrated stop-loss coverage and legal defense protection. (Non-believers need not apply).

The Texas School District Courtship Season Begins

TSHBP sent out invites last week to hear their sales pitch. Now TASB has sent out theirs. Who will be next?

TSHB has the more attractive offer – FREE FOOD and GIFT CARDS for attendees.

TRS ActiveCare is at a disadvantage since they are prohibited from competing for business for up to five years under certain circumstances.

ICHRA’s Rock

Attention Employers! Want to get out of the health insurance business? Want to give your employees more choices? Want to freeze your health insurance contribution no matter how much or how little you contribute?

Where Are All The Fat People?

Back in the day fat people were few in number. Now they are the majority of Americans. What happened?

Walmart Learns Human Labor Can Be Cheaper Than Machine Labor

Walmart Self-Checkout Scheme Backfires – INFLATION ALERT: Business overhead expenses for Walmart shopper thieves goes up.

A self-checkout machine doesn’t earn a salary or hourly wage. These silent, non-complaining beasts don’t need expensive company provided health insurance or Workers Compensation. They don’t get paid time off either. The little Beasties, it was thought, were going to reduce payroll costs and increase profits for the retail giant.

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

Oregon recently published the results of a study that confirm that by implementing a cap on facility prices at 200% of Medicare ( IP ) and 185% of Medicare (OP) for its state health plan, costs would eventually decrease. This is a good place to start but there might be another way to look at it as well:

Mark Cuban Fires His Insurance Consultant

“He first turned to the employee benefits consultant who had assured him he was getting a great deal—someone whose advice also cost $30 per employee per month.”

“That’s insane, that was millions of dollars,” Cuban says. “The person who put me into a program where I was paying eight times more than I should have for generic medication, they’re done.”

Around the time he dropped the consultant, Cuban was planning to get a CT colonoscopy, which he says would’ve cost more than $2,000 through insurance. Yet the walk-in cost for the same procedure was less than $500.

Will North Carolina Save $140 Million By Changing Logos?

The North Carolina state employee benefit program will be changing from Blue Cross to Aetna in 2025 for a purported savings. Sounds reasonable but is it true?

Call Armando For Price Check On Specialty Drugs

“Want to save $40,000 on a plan member taking an expensive specialty drug during the course of your plan year? Same manufacturer, same dosage. same packaging. We were able to do exactly that for a Texas county government health plan thanks to Armando. We turn to Armando when we need help sourcing expensive specialty drugs” – Bill Rusteberg

Highmark Small Group Community Rates

If you live in New York state and employ less than 100 employees, go here to see what your group health insurance rates could be under the Benefit Choices health program underwritten by Highmark (Rates shown are for Region 1).

Which Blue Cross Plan Has The Most Members? The Answer Will Surprise You

Largest Health Insurance Companies 2024

Chris Kissell

While some of these large health insurance companies are household names, others might seem obscure to the average consumer. What is the best health insurance company isn’t necessarily the biggest, but here is the list of the 50 largest health insurance companies in the U.S., and a deeper look at each of the top five.

TSHB Offers Free Food and Gift Cards For The Hungry & Gifted

At TSHBP’s 2024 Spring Regional Meetings explore cost-cutting solutions for districts and employees facing budget deficits.

Puppets On A String

United HealthCare says they have hired nearly 20,000 doctors in 2023 alone, according to reports. It also counts an additional 40,000 advanced practice clinicians among its ranks.

Hospital System Adopts Reference Based Pricing For 26,000 Employees?

Ardent Health Services with 26,000 employees, 30 hospitals and over 200 sites of care in six states partners with a legacy Reference Based Pricing TPA to administer their own employee health plan powered by “a powerful alternative to high-cost managed care networks.”

“Cry Me A River” by the Texas Hospital Association

What Texas hospitals got in 2023 as a reward for their service – from a coalition of health insurance interests and like-minded lawmakers – was blame, and even a degree of demonization.

Get Relief from Hospital Bills

Most hospitals offer discounts or bill forgiveness based on income. On average, a family of 4 earning less than $100,000 a year will qualify. We can help you apply — for free.

More Lloyds History By Miller

By Paul Miller

Here is part of an insurance claim made by Mme. Léontine Pauline Aubart, a first-class passenger aboard RMS Titanic.

Throughout her twenties, Mme. Aubart was a nightclub singer, living at 17 Rue Le Sueur, Paris. She boarded the Titanic at Cherbourg with her maid Emma Sägesser, occupying cabin B-35.

Aubart was the mistress of millionaire Benjamin Guggenheim, who was also travelling on the Titanic’s maiden voyage. After the collision, she and her maid entered Lifeboat No. 9. As they clambered aboard, Guggenheim spoke to Mme. Sägesser in German, saying: “We will soon see each other again! It’s just a repair. Tomorrow the Titanic will go on again.”