What if Your Credit Card Billed Like a Hospital

March 29th, 2015

 

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IMAGINE FOR A MOMENT…  Your credit card bill showed up in the mail stating nothing more than: YOU OWE $5,000

That’s it?   …I bet you are on the phone within seconds.    telephone123

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Cost Plus Insurance Reference Library

March 27th, 2015

cost plus

 

An assorted collection of articles for those interested in Cost Plus / Reference Based Pricing models

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AMPS Expands Texas Footprint

March 26th, 2015

aaaaa Growing business opportunities in Texas warrants a permanent footprint in the state. Houston targeted for AMPS newest office.

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Rick Scott Opines

March 24th, 2015

Rick Scott

Brooks Healthcare Solutions Fee Negotiation Services

March 24th, 2015

negotiatorBrooks Healthcare Solutions (BHS) has deep and broad relationships with hundreds of outpatient surgery centers across the country.

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Humana to sell Concentra for $1B

March 24th, 2015

bluelight130x130

Humana Inc. has revealed that it will sell Concentra……………

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Collapse of Southport Lane’s Insurance Empire

March 24th, 2015

Screen Shot 2015 03 21 at 10.43.47 AM

Alexander Chatfield Burns

A 28-year-old ‘financial prodigy’ built a hundred million dollar insurance empire that now might be worthless (see article at end of this post)

An insurance empire that included two insurance carriers, two offshore reinsurers, several buildings and other insurers’ investments was built by a private equity firm in part on questionable assets and is now being dismantled, according to the Wall Street Journal.

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Renting Medicare’s Provider Network

March 22nd, 2015

democratrepublican

An idea with bi-partisan support?

If the federal government would rent their Medicare network and charge what the private market charges for access, the government would rake in millions, if not billions of dollars in access fees. This would generate enough money to buy health insurance for those that don’t need it.

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Hospital Price Gouging Driving Up Healthcare Costs?

March 22nd, 2015

lustig

Victor Lustig “Why didn’t I think of this!

THE FALLACY OF HOSPITAL CHARGEMASTERS 

“Hospital industry claims that the charges  don’t matter because few actually pay the “list” price “defy common sense,” Burger said. “If there is no reason for the high prices, why bother charging them?” Burger asks.  See Hospitals Dismiss Significance Of Chargemaster Prices?

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Rio Grande City Independent School District Seeks Insurance Consultant

March 20th, 2015

rgc

The Rio Grande City Independent School District is seeking Request for Qualifications for fee based insurance consultant to assist the district in the evaluation of their Cafeteria Plan and products. Deadline to submit a response to the RFQ is April 30.

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Will AFLAC Shake Up Voluntary Employee Benefit Market?

March 20th, 2015

aflacAflac says it will now pay out certain voluntary benefit claims in one business day, an announcement that industry experts say will likely force competitors to follow suit.

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Cash Health Plans Make Sense

March 17th, 2015

Asserta Health provides enabling infrastructure for “cash” health plans that deliver significant cost savings by eliminating the “value drain” associated with the typical payment process. The entire healthcare transaction is simplified, transparent, and supported by a service model that effectively frees clinical and financial resources to focus on improving the cost, quality, and efficiency of the care itself. The result is a better healthcare experience—and outcome—for the consumer, the provider and the payer.

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Will H.B. No. 3453 Destroy TRS ActiveCare?

March 16th, 2015

Image result for run on the bank

Texas state representative J. M. Lozano filed House Bill (3453) on March 12, 2015. If passed the bill will take effect on September 1, 2015 and will allow participating school districts to leave TRS ActiveCare.

School districts currently participating in the TRS ActiveCare program are prohibited from leaving.

If districts are allowed to come and go as they please, adverse selection will begin an irreversible death spiral – TRS ActiveCare could end up being an insurer of last resort.

Should HB 3453 become law many expect a strong “run on the bank.” Will El Paso Independent School District be the first to leave? See El Paso ISD Votes To Leave TRS ActiveCare

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Drug Makers Form Alliance With Idiots

March 16th, 2015

idiot

“With the price of some treatments topping $100,000, patient (idiot) groups are pushing for state laws to make sure carriers (mean & nasty insurance companies) cover most of the costs. Their campaign is backed by an important ally: the drug industry.”

What these mental giants don’t seem to understand is that they are paying these costs through higher insurance premiums. The mean and nasty insurance companies simply pass on costs while taking their cut at the same time. And, with the Minimum Loss Ratio mandate in place the more the costs the more insurance companies are allowed to make. So these idiots are actually  screwing themselves by helping pharmacy manufacturers and insurance companies earn more money at their expense.

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San Benito ISD Considers Joining TRS ActiveCare

March 13th, 2015

sanbenitoisd

San Benito CISD Board Meeting 3-10-15  See 1:39 – 1:43 – this four minute segment gives the viewer a snapshot of San Benito’s self-insured medical funding problem.

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What If Restaurants Billed Like Hospitals?

March 13th, 2015

hospitalreciept2

Source: Clear Health Costs – www.clearhealthcosts.com

Not Insured & Pregnant? No Problem, We Got You Covered!

March 13th, 2015

freestuff

The Wall Street Journal reports that the Obama Administration is under pressure to allow uninsured women who become pregnant to enroll in Federal exchange plans at any time during the year.

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El Paso ISD Votes To Leave TRS ActiveCare

March 11th, 2015

grassisgreener

Greener Pastures Drive Move?

The El Paso Independent School District will petition the Teacher Retirement System to leave its statewide health insurance program because of rising costs to the district and employees. “It’s a hellhole” said Board President Margo

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New Mexico Rescinds Stop Loss Mandate

March 10th, 2015

raspa

Faster than a melting raspa, the New Mexico Superintendent of Insurance has rescinded the state’s new stop loss insurance mandate.

http://www.osi.state.nm.us/insurance-bulletins/docs/Bulletin2015-010.pdf

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Supreme Court Reopens Notre Dame Bid to Bypass Birth Control Coverage

March 9th, 2015

contraceptions1

Notre Dame contends the opt-out provision is insufficient to protect its religious rights.

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TRS ActiveCare Considers Plan Changes for 2015-2016

March 8th, 2015

angryteacher 

Are You Kidding Me! I can’t cover my husband anymore? And I lose my doctor too? What kind of plan is this!

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Potential Threat To Telehealth In Texas

March 6th, 2015

telehealthThe Texas Medical Board is attempting to change a rule that would restrict Texas businesses and citizens from utilizing telehealth services.

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Affordable Plumbing Act

March 6th, 2015

joe1

Michelle is not happy as she has Oprah and guests arriving the next morning.  The bucket fills up quickly and has to be emptied every hour, and there’s a risk the room will flood, so Obama calls Joe and pleads with him….….

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An Electrical Physical? How Much Is That?

March 6th, 2015

 

dayandnightclinic

“No, I am not doing an electrical physical, I’m here for a cold and I don’t need that test!” ……“But sir, your Blue Cross will cover it” came her soothing reply.

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A Closer Look at Berkshire Hathaway’s Insurance Operations

March 6th, 2015

Image result for warren buffett

“And all of this began with our 1967 purchase of National Indemnity for $8.6 million,” Buffett wrote…..“Last year, our premier position in reinsurance was reaffirmed by our writing a policy carrying a $3 billion single premium”

“How much is the premium did you say Warren, $3,000,000,000 for a single policy? 

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How Group Health Claims-Shifting Affects Workers’ Compensation

March 6th, 2015

unintended

Study predicts there will be more cost shifting to workers’ compensation as ACOs gain in popularity in the group health market. A good example of unintended consequences. ACA is chock full of unintended consequences………..

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Major Insurers Provide Medical Cost Information on New Platform

March 5th, 2015

Guroo logo

Prices for the same medical service vary widely across the country, and even within the same city. To help provide transparency on costs, some of the largest U.S. health insurers will now reveal the prices they pay for a number of medical services at Guroo.com.

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Montgomery Management

March 4th, 2015

Montgomery Management, a full service MGU, has been providing flexible, innovative stop-loss and life products to the marketplace since 1986. Our professional expertise, personalized service, corporate strength and stability make Montgomery Management an industry leader.

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Aetna Hits South Texas Hospital With $120 Million Kickback Lawsuit

March 4th, 2015

'No, I'm not part of an elaborate kickback scheme.'

“To hide the scheme, Aetna claimed that North Cypress consistently overcharged for routine procedures.”

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The Secrets of AmeriPlan® Corporation’s Discount Dentistry Uncovered

March 4th, 2015

darrell

By Darrell Pruitt, DDS

Until now, those who sell discount dentistry plans like Delta Dental, BCBSTX and AmeriPlan have always been less than transparent with naïve, vulnerable consumers about how their AmeriPlan-preferred dentists can discount their fees up to 80%, and still make a living.

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Stop The Arranged Marriages Between Patient & Provider

March 2nd, 2015

marriageThe outdated notion of assigning patients to doctors has repeatedly been shown to not work for patients or save money.

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N.C. Based Blue Cross Posts Loss, Blames Obamacare, Not Actuaries

March 1st, 2015

odds1

Blue Cross and Blue Shield says it has posted its first financial loss since 1999 as a result of insuring high numbers of older and sicker people under the Affordable Care Act.

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City of Fort Worth Releases Health Insurance Fund Balance Audit

March 1st, 2015

 

ftworth

The objectives of the audit were to review the consultant’s report and determine the reason for the difference in the consultant’s calculated change in the fund surplus versus the audited change in fund balance for the Group Health and Life Insurance Fund.

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Wellness Plans Don’t Work – Weight Loss Almost Always Come Back

March 1st, 2015

diet12

Yet another paper has been published on the waste of time, money and morale that results from the recent infatuation with wellness programs.

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Why Broker Health Plan Fee Agreements No Longer Work

March 1st, 2015

4 percent signWith the PPACA rules on mandatory minimum medical loss ratios (MLR) rules now in place, brokers should not be saddling clients with “fee” arrangements or underfunded commission agreements on medical policies.

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City of Santa Fe – In A Boat Without A Paddle?

February 28th, 2015

boat

By Molly Mulebriar

The City of Santa Fe has requested proposals for stop loss insurance for their self-funded employee health plan with a proposal deadline of February 23, 2015. However, New Mexico’s Insurance Superintendent issued a regulatory bulletin the week before the proposal deadline that effectively eliminates stop loss protection as a viable option for New Mexico employers that self-fund their employee health care coverage.

The task now before the city’s insurance consultant (AON Risk Solutions) and  third party administrator (United HealthCare – UHC) is to find stop loss insurance for the plan’s July 1 effective date. According to market experts this will be a near impossibility without divine intervention.  BUCA reps. are circling city hall anticipating the coming feast.

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Hospital Costs Explode Under ObamaCare – ACO’s A Cost Driver?

February 28th, 2015

Transcending Obamacare Fig 17

Thanks to federal intervention in the health care system—Medicare, Medicaid, and the employer tax exclusion—hospitals have been able to charge whatever they want for their services, knowing that the average consumer has no idea how much he’s paying, because he’s paying mostly through taxes and other indirect means…………..

Accountable Care Organizations, whose explicit goal is to encourage hospitals to consolidate the provider industry, thereby gives them more leverage to charge higher prices…………

The U.S. hospital industry is crony capitalism at its finest

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Stop Loss Carriers To Pull Out of New Mexico This Year?

February 27th, 2015

tissue1

Stop loss carriers are likely to exit the New Mexico market this year leaving self-insured medical plans without coverage.

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Higginbotham Unites Houston Offices

February 26th, 2015

higg

Independent insurance firm, Higginbotham, announced has united its three Houston offices under one roof and one operating name.

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Allstate Plans To Open Up New Agencies In Texas

February 26th, 2015

all

Allstate Insurance Co. has plans to approve 20 agency offices in the San Antonio and Austin markets this year as part of a broader plan to add 130 new agency owners in Texas.

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Humana, Weight Watchers to Help San Antonio Employees Get Fit

February 26th, 2015

obese

Humana Inc. and Weight Watchers International are teaming up to provide San Antonio employers that carry Humana health insurance the ability to give their workers the option of signing up for free and discounted access to weight-management services.

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These Doctors Work Hard – Over 24 Hours A Day

February 25th, 2015

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IBTX Risk Services of San Antonio Expands To Houston Market

February 25th, 2015

ibtxSan Antonio’s IBTX Risk Services will soon begin marketing risk-management services to clients in the Bayou City with the opening of the company’s new Houston office.

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CBS News Investigation Uncovers Compound Drug Scheme

February 24th, 2015

drugs1213

Last night, CBS Evening News aired an investigative segment about certain compounding pharmacies that have exploited industry loopholes to bill thousands of dollars for topical pain creams that don’t provide any clinical benefit.

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Can Government Tax Other Governments? ACA Challenge in Ohio

February 24th, 2015

tax1

“To put this simply, governments don’t tax other governments,” said DeWine. “This illegal taxation is another example of federal overreach the administration’s refusal to operate within the boundaries of federalism.”

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Profile Of A Great Account Manager

February 24th, 2015

seargent

“Account managers are like Army sergeants. A well seasoned sergeant makes sure the goals of the officer corp are reached and they only have to take an order once to get the job done. Failure is not an option……..”  

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Insurance Agent Touts Cost Plus Insurance – Is School District Receiving Fair Value?

February 23rd, 2015

domino

“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”

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National Underwriting Services Inc.

February 22nd, 2015

National Underwriting Services, Inc., (NUS) is a Managing General Underwriter providing stop loss solutions for self-funded employers. Founded in 1985, NUS is located in the beautiful Texas Hill Country near San Antonio, Texas.

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San Benito ISD – TRS ActiveCare To The Rescue?

February 22nd, 2015

SuptsScoop_2

Why did our fund balance fall so sharply last year?  And why is it still declining?  Our decline in fund balance is primarily due to our self-funded health insurance program, which is simply not sustainable as presently designed.

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Proposal Would Offer Wisconsin State Workers $2K to Opt out of Health Coverage

February 22nd, 2015

carrot

February 20, 2015

Wisconsin Gov. Scott Walker is proposing that state employees be offered $2,000 a year to opt out of state health insurance coverage.

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1115 Waiver – Pay Me $1 And I Will Give You $3 Back

February 22nd, 2015

beto Beto Salinas

The 1115 Waiver is a federal program meant to provide incentives to taxpayers to become more dependent upon government. It takes political courage to recognize the 1115 Waiver for what it is. Mayor Beto Salinas of Mission, Texas is a rare man of courage………

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Pacesetter Provides Self-Funded Option For Groups of 5+

February 21st, 2015

Image result for nexus marketing group

Now groups with as few as 5 employees can take advantage of self funding…….

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Healthcare Highways – A Sensible Approach To Health Care Access

February 20th, 2015

Entrepreneurial Spirit and the drive to do things differently

Healthcare Highways is a new, innovative health plan partnered with providers, employers, payers and other strategic business relationships to develop and offer a real choice in the delivery of healthcare.

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Innovative Stop Loss

February 20th, 2015

Orein Risk Analysts, Inc., has a unique stop loss insurance product that provides plan sponsors with the ability to budget for future expenses with stop loss terms locked in over a three year period.

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2017 – The End of Employer Sponsored Health Insurance?

February 20th, 2015

streesed

Health Insurance Broker Contemplates Future

ACA Allows States to Open Exchange To Big Employers in 2017.

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TSTA Recommends TRS ActiveCare Opt Out Provision

February 18th, 2015

outofhere

Guthrie also said that the legislature would have to change the law to allow districts to opt out of ActiveCare, which TSTA supports.

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Anonymous Phone Call Sparks Interest At Harlandale ISD Insurance Procurement Process

February 18th, 2015

phonecall

The Harlandale ISD board of trustees will discuss Tuesday whether to have outside law enforcement agencies investigate former board president Velma Ybarra for possible violations of state procurement laws.

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Opinion: Three Ways ObamaCare Must Finish The Job

February 17th, 2015

dendy Mike Dendy

No one will bring down America’s highest-in-the-world health-care prices until consumers and the employers who pay for most privately financed care know what the prices actually are, says Mike Dendy, CEO of Atlanta-based Advanced Medical Pricing Solutions. Americans not only pay the world’s highest prices for care, but what they pay varies wildly from doctor to doctor, hospital to hospital.

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Democrats Seek Relief From ACA Penalties

February 17th, 2015

 

Prescription Drug Costs Plague Plan Sponsors

February 15th, 2015

zombie What! A $10 co-pay!

“Why are patients paying more for health care?  It’s the drug prices…….increasing 13% last year alone…”

ObamaCare Solution: Bronze Plan $6000 deductible with no first dollar coverage. Rx covered after satisfaction of deductible, and is a reimbursement benefit to the insured (insured pays for Rx with cash, then files claim like in the old days…..)  A patient who must pay cash up front before reimbursement will be a better consumer with skin in the game instead of an entitlement zombie who could care less about what costs are other than that egregious $10 co-pay.

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Avoid Doing Business With The Government Doc – They Will Own You

February 13th, 2015

biggov

“CMS: Meaningful Use penalties to reach $200M – Current CMS data indicate that eligible professionals are facing an estimated $200 million in Medicare reimbursement penalties in 2015 for failure to fulfill Medicare meaningful use obligations. The numbers were announced this week during a HIT Policy Committee meeting.” By Heather Caspi, February 13, 2015. (more).

http://www.healthcaredive.com/news/cms-meaningful-use-penalties-to-reach-200m/363963/

Regardless whether the eligible professionals deserve the claw-back penalties or not, the important lesson here is: Do everything you can to avoid doing business with the U.S. government, Doc. They will own you.

Dr. Pruitt – darrelldk2@gmail.com

If Mechanics Were Paid Like Doctors

February 12th, 2015

mechanic

“My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen — and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing something he loves, and his dream had always been to open his own garage.”

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Socialism

February 12th, 2015

“The problem with socialism is that you eventually run out of other peoples’ money.” – Margaret Thatcher

The Rapid Growth of Telemedicine

February 12th, 2015

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Lucent Health Solutions Completes Acquisition of Capitol Administrators

February 12th, 2015

NaviMedCapitalLucentHealthSolutions

Second Acquisition in Three Months for New Employer Healthcare Benefits Platform

(Sacramento, California) January 16, 2015―Lucent Health Solutions, Inc., in conjunction with NaviMed Capital, a Washington, DC‐based healthcare growth capital firm, announced today its acquisition of Capitol Administrators Inc. (Capitol).

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Affordable Care Act Startups in Poor Financial Health

February 11th, 2015

money1

Obamacare’s startup health insurance plans are flirting with financial distress, as all but five of the 23 nonprofit companies had negative cash flow from operations in the first three quarters of 2014, Standard & Poor’s said in a report today.

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Comrade Obama Blasts Staples, Attacks Capitalism

February 11th, 2015

camrade

“…..when I hear large corporations that make billions of dollars in profits trying to blame our interest in providing health insurance as an excuse for cutting back workers’ wages, shame on them,” Obama”

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Christus Santa Rosa Restructures Domestic Operations

February 11th, 2015

Patrick Carrier

Patrict Carrier, CEO Christus Santa Rosa

“Christus Health, which operates hospitals in several Texas cities and in Louisiana, New Mexico, Chile and Mexico, is reducing the number of its domestic operating units from eight to three. Carrier said the changes will streamline and simplify Christus’ regional operations and expedite the decision-making process across all affected markets. He will divide his time between both markets.”

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American Success Story

February 10th, 2015

adam Adam Russo

From its simple beginnings in my mother’s basement to our current status as an industry leader, even I, confident as I was that we’d succeed, am shocked and grateful for the level of success we’ve achieved together.

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City of McAllen, Texas Seeks Competitive TPA Proposals

February 10th, 2015

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Texas Wholesale Brokerage Community Outraged!

February 10th, 2015

outraged Surplus Lines Agent

“To say the move both surprised and shocked the state’s wholesale insurance broker community would be an understatement.”

“Few were willing to speak publicly about it. However, off the record many members of the Texas MGA community expressed frustration and confusion — in some cases disgust — that the largest state affiliate of the Big “I” would go into direct competition with them in the wholesale insurance marketplace.”

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Brownsville ISD Insurance Controversy Update

February 6th, 2015

 

klement

Update on previous post: ADMINISTRATION IGNORES BOARD, AWARDS $3.3 MILLION INSURANCE TO SAME VENDOR, CONSULTANT

Vendor writes complaint letter to BISD – Klement Letter

ADMINISTRATION IGNORES BOARD, AWARDS $3.3 MILLION INSURANCE TO SAME VENDOR, CONSULTANT

February 6th, 2015

life

“This is the kind of stuff that the FBI is looking for,” said a BISD administrator. ”

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Texas Senator Files Bill Over Pricing At Freestanding Emergency Rooms

February 5th, 2015

eroom   ER at Bull Run

“As I speak to folks in my district, I regularly hear stories of confusion regarding the difference between urgent care clinics and these freestanding emergency rooms, which are generally far more expensive,” the Republican from Georgetown said.

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Zarate Pharmacy, Opening Day Prices, 1946, Brownsville, Texas

February 5th, 2015