UHC Gifts Millions To Address Food Insecurity

August 18th, 2022

With obesity running rampant it would seem food insecurity affects very few these days. A quick visual confirms a majority of Americans have successfully solved food insecurity in this country. Those unfortunate few that haven’t are rejoicing with the news UHC is coming to the rescue……………

Read the rest of this entry »

NAIC Passes Dog & Cat Insurance Model Act

August 17th, 2022

Dogs and cats are happy today after the NAIC passed the Pet Insurance Model Act. Dogs are barking and cats are purring all across the Fruited Plains after hearing the news.

“Finally, we’re not subject to stringent pre-existing conditions” said Boudreaux Wilson the 3rd, a Blue Healer mix from Yoakum, Texas. “Are we gonna get government subsidies next?”

Read the rest of this entry »

Government Gifts $64 Billion To Health Insurance Companies

August 17th, 2022
Bernie Would Have Been Proud

While you were sleeping the government passed a new law which includes $64 billion to extend a policy under Obamacare to reduce health insurance costs. TRANSLATION: Government just gifted $64,000,000,000 to American health insurance companies to be disguised as “subsidies”, a politically correct term for “welfare payment.”

Read the rest of this entry »

Walks Like A Duck, Acts Like A Duck, Looks Like A Duck

August 16th, 2022

Level funding is a form of self-funding that looks, acts, and feels like a fully-insured plan. It’s ideal for groups who have low risk tolerance and who want all the guarantees and safeguards of a fully-insured plan.

Read the rest of this entry »

Plan Document Language That Makes Sense

August 15th, 2022

Plan sponsors provide employees “health care expense accounts.” This is called health insurance. Like most company expense accounts there are stipulations employees must abide by.

Read the rest of this entry »

The Patient Will See You Now!

August 14th, 2022

At Revive, we have a saying: “The patient will see you now.” That’s because we’ve created a solution that puts patients in charge of their care and addresses the current challenges of the health care system.

Read the rest of this entry »

5 Reasons Virtual Primary Care Is Going Viral

August 14th, 2022

As a physician, I agree with the majority of my peers who expect virtual primary care to surpass in-person care within five years…………………….

Read the rest of this entry »

Another BCBS Plan Buys A TPA

August 14th, 2022

Blue Cross of Alabama has been buying up small regional TPA’s and rebranding under the name 90 Degrees Benefits. Blue Cross of North Carolina owns a TPA too. Now we see more BCBS plans entering the TPA market. Here’s the latest……

Read the rest of this entry »

Another Entrant Into The Level Funded Market

August 14th, 2022
There’s More Than One Way To Skin A Cat!

Level Funded Stop Loss insurance provides all the benefits of self-funding by retaining all unused funds, lower maximum costs, no lasers, and flexibility in plan design.

Read the rest of this entry »

DPC + 501r = Almost Free Health Care

August 13th, 2022

By Doug Aldeen – ERISA Healthcare Attorney and General Counsel

95 million American earn less than $35,612 or 275 percent of the FPL. Why pay for anything other than DPC with a 501 r wrap?

Read the rest of this entry »

South Texas Insurance Broker Is Abnormal

August 12th, 2022

Alex Zuniga is an independent insurance broker / consultant in deep South Texas who doesn’t fit the mold. He’s different.

Read the rest of this entry »

Come & Get Your Copiers

August 12th, 2022
Copy Machine Salesman Responds

“Come and get your copiers” says the City Manager. “But we have a five year contract!” says the vendor. “Doesn’t matter” says City Manager ……………………

Read the rest of this entry »

Cano Health Direct Primary Care

August 12th, 2022

Our friendly drivers will pick you up, take you to your appointment, and then bring you back home – all in the comfort of our specialized vehicles. And we will deliver your prescriptions to your home at no cost to you.

Read the rest of this entry »

Radion Health

August 12th, 2022

Level funded health plans are becoming a viable option to fully-insured plans. Radion Health has all the right selling buttons………………………..

Read the rest of this entry »

Holy Smoke – Group Health Plan To Add 87,000 Employees

August 11th, 2022

The economy must be thriving these days. Business must be booming. The nation’s largest employer whose revenue this coming year will break all previous records will be adding 87,000 new employees to their health plan.

Read the rest of this entry »

DPC Outlaw Comes To Town

August 11th, 2022
Patients Spending Quality Time At The Doctor’s Office

Remember Xerox? How about Eastman Kodak? Both were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before. Now we are seeing something similar in health care……………….

Read the rest of this entry »

868 Wasteful Drugs

August 10th, 2022
Read the rest of this entry »

You Are Required To Know – It’s The Law

August 10th, 2022

By Patrick Moore on linkedin

If you’re a CFO or HR expert then you really need to hear me on this: You are now required to know how much money people are making off of your healthcare budget.

Read the rest of this entry »

Are You A Genius? Try This To Find Out

August 9th, 2022
Read the rest of this entry »

WOW!

August 9th, 2022

Comprehensive
healthcare benefits with
nationwide access

We bring you transparent access with direct-pay medical providers who get paid at the time of service so the patient is not billed afterwards! Our comprehensive network of doctors, dentists, pharmacies, labs, and everything in between for a truly complete healthcare package.

Read the rest of this entry »

Size Doesn’t Matter

August 8th, 2022

Everyone thinks size matters when purchasing employer sponsored medical insurance. It doesn’t

Read the rest of this entry »

Ruben Edelstein

August 7th, 2022

By Bill Rusteberg

Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.

Read the rest of this entry »

Marpai To Acquire Maestro Health

August 7th, 2022

First there was Continental Benefits. Then there was Marpai. Now there is……………………..

Marpai To Acquire Maestro Health

MyHealthGuide Source: PRNewswire, 8/4/2022

NEW YORK — Marpai, Inc., an AI-technology company transforming the $22 billion TPA market supporting self-funded employer health plans, announced it has signed a definitive agreement to acquire Maestro Health (“Maestro”), a leading TPA servicing over 80 self-insured employers, based in Chicago, Illinois. 

Read the rest of this entry »

Fully-Insured Rx Plans

August 7th, 2022

A carved out custom fully insured prescription drug benefit plans for the large group health benefits marketplace? This is interesting. Will this lower the cost of drugs?

Read the rest of this entry »

Death Claims Rise 40%

August 7th, 2022
Read the rest of this entry »

N. Korean Hospital Pre-Certification Program

August 7th, 2022

In the N. Korean model, patients play an important role in the “pre-certification process” which is tied to a per admission “deductible” intended to speed up access to needed healthcare……………………

Read the rest of this entry »

Aldeen’s Sunday Morning Bathroom Read

August 7th, 2022

By Doug Aldeen

Sunday morning bathroom read (Deep Thoughts by Jack Handy “SNL” edition):

Read the rest of this entry »

We Have A Problem With Fat People

August 6th, 2022

“We’ve gone from fat acceptance to fat celebration. To view letting yourself go as a point of pride? The term body positivity is used to mean ‘I’m perfect the way I am because I’m me.’ It’s Orwellian.” – Bill Maher

Read the rest of this entry »

Legacy Health Insurance Brokers Are Bad For Your Health

August 6th, 2022
Spreadsheet Sam Busy At Work

Legacy health insurance brokers are worthless. They’re bad for your financial health. They’re lazy, dumb and often great golfers.

Read the rest of this entry »

City of Raymondville Seeks Competitive Health Insurance

August 5th, 2022

Here’s an opportunity for health insurance brokers to earn big bucks by simply forwarding this RFP to the four or five remaining fully insured carriers active in the market. Effortlessly, lift your index finger, gently tap the send button, and email the link below to your favorite BUCA rep. They’ll do the work while you play.

Read the rest of this entry »

The Full-Risk Capitation Model: Why Make the Change?

August 5th, 2022

By Christopher Chen, MD

Consider a typical primary care doctor who sees 30 patients a day, generating some $600,000 in a year ………………………..

Read the rest of this entry »

It’s time to expose the secret drug scam at the heart of American health care

August 4th, 2022

BYHOWARD DEAN

July 26, 2022 at 4:47 AM CDT

In 2021 alone, pharmaceutical firms provided a staggering $204 billion in price concessions for brand-name medicines–but the funds have mostly benefited insurers and their pharmacy benefits managers.

A federal court recently exposed the rot at the heart of America’s health care system.

Read the rest of this entry »

The Primary Care Gold Rush

August 3rd, 2022

Retailers, payers and startups could capture 30% of primary care market by 2030: report

By Heather LandiAug 2, 2022 12:30pm

Bringing new care and reimbursement models to the market along with a bigger focus on virtual care, these nontraditional players are gaining traction and have the potential to grab as much as a third of the U.S. primary care market by 2030, according to a new report from Bain and Company.

Read the rest of this entry »

Revive Health Expands Growth Trajectory

August 3rd, 2022
ReviveHealth

Emerging Leader Accelerates Growth Trajectory and Market Penetration

PONTE VEDRA BEACH, FL / ACCESSWIRE / August 3, 2022 / ReviveHealth™, Inc. has announced they have acquired ManifestRx™, an innovative national digital pharmacy services platform, as they continue their quest to become a preeminent leader in digital health whole-person care.

Read the rest of this entry »

How Would You Deal With An Unexpected $1,908 Hospital Bill?

August 2nd, 2022

The parents of Maddux Brown saved big when they learned that nonprofit hospitals are required to provide financial assistance. You and your loved ones could, too!

By Marshall Allen

When 6-year-old Maddux Brown underwent a 15-minute surgical procedure his dad Jason didn’t expect the bill to empty his bank account. 

Read the rest of this entry »

How To Secure Good PBM Contract Terms

August 2nd, 2022

“If your PBM contract pricing includes AWP-X% you are getting screwed. If the contract also includes MAC pricing you’re getting doubly screwed” – Molly Mulebriar

Read the rest of this entry »

“Abusive” Blog Reinstated

August 1st, 2022

RiskManagers Blog has been down the last few days with readers getting the message “Access is not available on account of abusive activity.”

Read the rest of this entry »

PE-backed Zelis buys Spectrum’s Payer Compass

August 1st, 2022

By Sarah Pringle

Zelis Healthcare, backed by Parthenon Capital and Bain Capital, has agreed to acquire Payer Compass for roughly $180 million, sources familiar with the matter tell Axios.

Go deeper (2 min. read)

800 Life Case Seeks Health Insurance Proposals

August 1st, 2022

This 800 pound gorilla is located in deep South Texas, in the Lower Rio Grande Valley.

Read the rest of this entry »

Texas School District Explains How They Solved Health Care

July 30th, 2022

Dr. Benjamin Clinton explains how the poorest school district in Texas solved health care………..

Read the rest of this entry »

Blue Cross Gives Small School District Better Deal than TRS ActiveCare

July 23rd, 2022

Blue Cross has given a small school district in deep South Texas a better deal than TRS ActiveCare with over 400,000 members………………. Read the rest of this entry »

When Reason & Logic Won’t Win The Argument, Arm Twisting Will

July 23rd, 2022

By Bill Rusteberg

I’ve been dealing with hospital administrators since the 1970’s and during the years since little has changed. I know exactly what the hospital administer will say and do during the negotiation process, their tactics, including the traps they set for amateurs.

Read the rest of this entry »

You Don’t Want Me To Know Your Business Because It Won’t Be Good For You!

July 22nd, 2022

By Bill Rusteberg

Recently I was referred to a large medical group that was interested in learning more about how we help plan sponsors manage their employee health care needs. They were fully-insured with a BUCA and tired of double-digit rate increases year after year.

Read the rest of this entry »

Panning for Gold – The Great PCP Gold Rush

July 22nd, 2022

Amazon is acquiring One Medical for $18 a share, an all-cash deal that values the primary health-care provider at roughly $3.9 billion, the companies said Thursday.

Read the rest of this entry »

A Cure For The Royal Disease?

July 21st, 2022

New England Journal of Medicine reports a transformational therapy has effectively cured the Royal Disease………..

Read the rest of this entry »

Source of All Evil – Woke HR Departments

July 21st, 2022

Separating The Sheep From The Goats – Matthew 25:31–46

I have hated this business for a long time but I love being an outlaw helping companies escape the prevailing death spiral…………………………..

Read the rest of this entry »

Build Your Own RX Plan – Bypass Predatory Business Models (PBMs)

July 20th, 2022

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

By Bill Rusteberg

Building a Rx benefit plan without a PBM (Predatory Business Model) is beginning to make sense for plan sponsors whose Rx costs are as high as 50% of total plan spend. They no longer view their plan as a health plan but as a Rx plan with health benefits attached.

Read the rest of this entry »

My Dog Has Better Health Insurance Than I Do!

July 18th, 2022

While chasing a squirrel in the woods, beloved pet dog tore the anterior cruciate ligament in her left knee. Turns out she had better insurance than her master………………………………

Read the rest of this entry »

And Now…………The Rest of The Story

July 18th, 2022

If Paul Harvey were alive today and had read the following article, he would have found fertile material for his “The Rest of The Story” radio show…………………………

Read the rest of this entry »

Plan Sponsors To Lose Discretionary Authority?

July 18th, 2022

Plan Sponsor Employs Discretionary Authority

Does your plan contain a discretionary authority provision? The government may be taking that away if HR 7740 passes. It will prohibit arbitration in ERISA claims and discretionary authority clauses.

Read the rest of this entry »

PBM Shell Game – Hiding Fees Through Middlemen

July 17th, 2022

Are PBM’s Adding Another Middleman To Avoid Transparency?

Are PBM’s creating another intermediary in the supply chain to prepare for transparency requirements? They stand to lose a lot if they get regulated on rebates. By creating another organization that’s offshore, they can protect their interests…………….

Read the rest of this entry »

Wife Saves Husband – Stuns Doctors

July 16th, 2022

AUSTIN, TX – “He’s turning into a shell of his former self”, his wife cried.

Lee had become so frail that it took every ounce of energy just to hoist himself out of his scooter and into his favorite Lazy Boy.

Read the rest of this entry »

Underwriting Health Insurance Plan Made Easy

July 16th, 2022

Formulas for establishing health insurance renewal rates:

Read the rest of this entry »

US Allows Pharmacists to Prescribe Paxlovid Directly

July 15th, 2022

Article Referred By Jody Bright

Pharmacists can now prescribe Paxlovid, Pfizer’s COVID-19 antiviral pill, directly to patients.

Read the rest of this entry »

U.S. Online Pharmacy Offers Huge Savings

July 15th, 2022

Prescription drugs don’t have to be as expensive as they are. A smart plan sponsor, thinking out of the box, would discover tremendous savings if they seize advantage of opportunities available in the free market.

Read the rest of this entry »

Villains of Health Care

July 15th, 2022

“Pharmacy Benefit Managers are one of the three most influential opponents of price transparency……………….. If the true cost of a medication were known this would shine a light on the fraud taking place, so the PBMs hide the costs at every turn”

Read the rest of this entry »

Only 26 Percent of U.S. Physicians Are Still Independent. Why?

July 14th, 2022

SOURCE: Vitori Health

Twenty years ago, nearly two-thirds of doctors were independent practitioners. Today, only one-quarter remain independent.

Read the rest of this entry »

Government Sponsored Adverse Selection

July 13th, 2022

Once Upon A Time there was a young man in dire need of medical care but he had no insurance………….

Read the rest of this entry »

Law Firm Manages & Reduces Risk For RBP Plans

July 12th, 2022

Protecting patients,
health plans and insurers
across the U.S.

“We engaged Koehler-Fitzgerald in 2015 to represent covered employees of health plans we provide administration to that have adopted reference based pricing. They have been very responsive to the needs and questions presented by plan sponsors, plan members, and our staff. Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. Knowing that every participant has legal representation from a high quality, experienced law firm provides our client plans and employers confidence that their employees will be properly protected from the many aggressive balance billing practices that a small portion of hospitals and other medical providers attempt to employ. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.” – Jim Farley, J.P. Farley Corporation

Read the rest of this entry »

Poll – 99.999% of Americans Hate Their Health Insurance

July 12th, 2022

A national poll conducted by the Molly Mulebriar organization found 99.99999% of Americans hate their health insurance. The primary reasons cited include affordability.

Read the rest of this entry »

Asserta Seeking Investors @ $7.95 Per Share

July 11th, 2022

Asserta is offering investors an opportunity to share in a fast growing segment of the American health care system of finance providing employers significant savings on health insurance costs while removing financial barriers and improving member experience for working Americans ………………

Read the rest of this entry »

Specialty Drugs Are Bankrupting Health Plans

July 10th, 2022

Specialty Drugs Have Consequences 

During the interview process Joe Sixpack learns the position pays $35,000 plus benefits. Little does the employer or Joe know the true cost was going to end up being $650,000…..the equivalent of 18 jobs………..so to keep from bankruptcy the employer must reduce his workforce by 18 (hopefully non-essential) employees and freeze wages for everyone else ………….or move his manufacturing business to China and his $685,000 per year employee to unemployment.

Read the rest of this entry »

Voya Health Solutions* Expands Stop Loss Presence in The Mid-market

July 10th, 2022

MyHealthGuide Source: Voya Health Solutions*, 7/5/2022

Voya Health Solutions* is pleased to announce their continued expansion into the mid-market beginning with quoting on July 1, 2022.

Read the rest of this entry »

The Firemen Are Arsonists

July 9th, 2022

“The supposed firemen are arsonists…getting rescued and then robbed shouldn’t happen”.

Read the rest of this entry »

Finally, A Wellness Program That Makes Sense

July 8th, 2022

Rancho Pescadero Wellness Center offers a unique approach to wellness…………….

Read the rest of this entry »

Questions For Non-PBM, PBM Experts

July 8th, 2022

This blog entry is directed towards PBM experts who are not PBM’s or employed by a PBM. We are searching for the truth about the deep black vortex of the PBM world……………

Read the rest of this entry »

Carving Out Specialty Drugs May Have Consequences

July 7th, 2022

“Reimbursements for overrides are taxable if not provided a written plan as required by Code Section 105. If taxable, reimbursements should be reported on employee W-2s and all applicable income and employment taxes should be withheld and reported as required by the IRS….”

Read the rest of this entry »

The RBP Okey-Doke

July 7th, 2022

“Pssst….Godfather, We’ve Been Exposed!

The following account is based on a true story.

If a Reference Based Pricing plan pays medical caregivers 120% of Medicare, what is the Plan Sponsor paying?

Read the rest of this entry »

Brokers Rejoice! Compensation Disclosure Not Required For Non-ERISA Groups

July 6th, 2022

“Prudent plan fiduciaries will establish and adhere to a formal, written policy to ensure compliance with the New Disclosure Rule. Indemnification and limitation of liability provisions in service provider contracts should also be revisited relative to this new rule.”

Read the rest of this entry »

Texas School District Wins “Highest Cost Health Insurance” Award

July 4th, 2022

Eagle Pass Independent School District has got to be paying more for health insurance than any other school district in Texas…………………..

Read the rest of this entry »

Aldeen’s Sunday Morning Bathroom Read – Happy July 4 Edition

July 4th, 2022

By Doug Aldeen

Sunday morning bathroom read (Happy 4th of July): Slowly but surely (more like a glacial pace) the python like grip of the industrial medical sick complex is loosening… .

Read the rest of this entry »

Elected Official Mad As Hell – Hospital Cartel Crushing Middle Class

July 4th, 2022

“Some things are worth getting mad about. The hospital cartel is using taxpayer dollars to help crush the middle class and rob lower-income families of upward mobility…………Wealthy hospitals took billions of taxpayer dollars meant to protect struggling hospitals — and then some billed poor families or even sued patients.” – State Treasurer Dale R. Folwell, CPA

Read the rest of this entry »

Bella, Erec and Lotta

July 3rd, 2022

 

Dogs are “superior smellers” and are already used to detect what the human nose typically cannot from diseases, such as Parkinson’s, cancer and diabetes, to drugs and explosives in public places, according to the American Lung Association.

Read the rest of this entry »

Free Health Care Por Los Mojados

July 3rd, 2022

California will become the first state to remove immigration status as a barrier to health care, making all low-income illegals eligible for state-subsidized healthcare regardless of age.

Read the rest of this entry »

Dr. Banting Patented Insulin Over 100 Years Ago For $1. What Happened?

July 3rd, 2022

4 Out Of 5 Americans With Diabetes Went Into Debt To Pay For Insulin, New Survey Shows

By Deb Gordon

Amidst rising inflation, Americans are feeling the squeeze of higher prices on everything from gas to groceries. But when inflation bumps into the already rising cost of drugs such as insulin, the impact can be serious and the stakes are high.

Read the rest of this entry »