The Affordable Care Act

November 19th, 2019

Size Doesn’t Matter

November 17th, 2019

Size doesn’t matter when it comes to health care……….

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Cost Shifting Is Silly

November 17th, 2019

Status quo strategies used to reduce health care spend by employers includes cost shifting to plan members. Higher deductibles and higher out-of-pocket costs reduces insurance premium costs but not health care costs.

Back in the day a health insurance deductible equaled one week’s worth of pay. A $100 deductible was standard back in 1975.

Now it’s not uncommon to see annual deductibles of $4000 and more, much more.

It’s evident cost shifting has not tamed the healthcare beast.

And it’s clearly evident size doesn’t matter. A +400,000 life self-funded health plan in Texas has been practicing cost shifting for years. 64% of plan members are on a $2,750 front end deductible with no first dollar coverage (except for preventive care) before benefits are paid.

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Arthur J Gallagher 10k Report

November 16th, 2019

The Arthur J Gallagher 10k 145 page report for the fiscal year ending December 31, 2018 provides interesting insight into insurance brokerage services.

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A Health Care Strategy That Makes Sense

November 14th, 2019

         Status Quo Broker Reacts

THE STRATEGY

Allow providers to name their price and mold the member and plan responsibility around that.

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Cash Pay Health Plans Save 50% or More

November 12th, 2019

“Paying cash to see the doctor out of network cost less than half of seeing the same doctor in-network with insurance.”

Plan sponsors should adopt cash pay strategies as many of our clients have done with good success. Whereas a typical PPO plan will pay (with your money) as much as 225% – 400% of Medicare, our cash pay program pays ( with your money) Medicare rates or below on average.

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Veterans Day 2019

November 10th, 2019

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.

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Apaly Health Launches Direct Contracting Solution

November 10th, 2019

“Will my doctor accept our insurance” ….………… “Yes, unless he’s an idiot.” 

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Learn A Foreign Language – Become Bilingual

November 9th, 2019

Learn a foreign language in the comfort of your home! You will be glad you did! Never again scratch your head and wonder what the heck that health insurance salesman was trying to convey during those dreadful renewal meetings. Stop relying on body language! Become empowered NOW!

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Catastrophic Claims on the Rise

November 5th, 2019

There is no doubt catastrophic claims are on the rise. Turbo-charged hospital bills reach the ever present stop loss outlier provision (common to most managed care contracts) faster than a melting Raspa in deep South Texas on a hot day in August.

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20 Year Old Starts Hospital Charity – Now The Rest of The Story

November 1st, 2019

Hello Americans. I’m Paul Harvey. You know what the news is —– in a minute you’re going to hear the rest of the story……………………..

At 20 years old Eric started a hospital charity to benefit children in need of health care. It was a noble endeavor. In less than 10 years, he raised more than $20 million for terminally ill children at Saint Jude Children’s Research Hospital in New York. His charity maintained just over a 9 percent cumulative expense ratio, one of the lowest expense ratios of any charity in the nation, and funded the construction of one of the most cutting edge intensive care units and surgery centers dedicated to children.

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Raising Drug Prices Is A Moral Requirement

November 1st, 2019

Raising drug prices is “a moral requirement,” says Nostrum Labs CEO.

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Predatory Billing, Scare Tactics, Boggus Prices

November 1st, 2019

Many hospitals are more interested in extracting money from vulnerable patients than providing quality care at a fair price………………but greedy healthcare participants like hospitals don’t have quite as much leverage as they’d like us to think………………..

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BCBS Swims In Cash

November 1st, 2019

Your BCBS renewal could be the beneficiary of a reserve buy-down in 2020 which means lower than normal rate increases. New business rates should be below market too. That’s because “A $1.7 billion tax refund under the Trump administration’s tax cuts drove a 226 percent rise in net income to $4.1 billion, from $1.3 billion the year earlier.” 

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The God Father of Reference Based Pricing is…………………………

October 31st, 2019

By Molly Mulebriar

There appears to be some confusion these days as to rightful owner of the title God Father of Reference Based Pricing.  

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Texas Sues Aliera Healthcare

October 29th, 2019

Texas Department of Insurance estimates that Aliera has about 17,000 customers in Texas and 100,000 nationwide.

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The Case of The $153,887 Kidney Stone

October 29th, 2019

“The patient spent 1 hour in the OR.  I kid you not, the facility billed $153,887……….”

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Non-Profit Hospital Defends Finances

October 28th, 2019

“Over the past few weeks, several articles and “studies” have been filled with inaccuracies and, at best, incomplete analyses of Parkview Health’s financial position, with calls to invest more in the community. I never expected having to defend what Parkview does for the community, but I will, and I’ll also provide some context regarding our financials.”

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Price Transparency Be Damned – I’m Insured Through OPM Insurance Company

October 27th, 2019

“Americans usually put relationships ahead of money” because the money is not really theirs. “Once patients find a physician they trust and a hospital they like, they tend to stick with them even if there is a lower-cost alternative nearby” because, after all, they use Other People’s Money. No one ever cares about health care costs when using Other People’s Money (insurance). Transparency be damned………………………

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Changing TPA’s – I’d Rather Grin & Bare It!

October 26th, 2019

By Molly Mulebriar

How many times has an employer said to you “Yes, we ARE having issues with our TPA, but changing to another one is too disruptive and challenging. Plus, we are out of time since our renewal is just around the corner. We are just going to stay put for now and live with it.” Read the rest of this entry »

HCA Sued Over Cover Charge

October 23rd, 2019

A $3,935 cover charge? No problem! I’ve got Nightclub Insurance! Let’s party………..

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Insulin Patent Sold For $1 Almost 100 Years Ago – What Happened?

October 23rd, 2019

By Carl C. Schuessler, Jr., DHP, DIA, GBDS

Organized crime – this is killing diabetics…………………

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Experiment Induces Confused Supposition

October 22nd, 2019

Do retail pharmacies make more or less money through PBM contracts?  If they make less money is it to a point they lose money?  Or do they profit? Before asking your pharmacist, try this experiment first.

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Benefit Administrative Systems, LLC

October 20th, 2019


Founded in 1983, BAS is a results-driven third party administrator with a track record of delivering cost savings and customer satisfaction. We utilize our services, tools, and partners to create a robust partially self-funded plan as unique as each client.

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UnitedHealth Loses Two Big Accounts – Big Wins for Humana & Aetna

October 17th, 2019

UnitedHealth Group Inc. will lose two large customers in its retiree health-care business next year, a setback for the insurer in an increasingly competitive marketplace for senior medical benefits.

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Teacher Retirement System Considering Big Changes

October 14th, 2019

Formerly sleepy TRS trustees are considering “big changes” to TRS ActiveCare because member districts are threatening to leave to establish their own health plans. Competition, for the first time, is clearly at play here (Texas School District Challenges TRS ActiveCare Plan Mandates).

The TRS solution? Eliminate community rating so some districts can pay more and utilize narrow networks so all districts have less choice……………………..

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What’s at Stake in the Current Court Challenge to the ACA?

October 14th, 2019

Lord Roberts -Protector & Defender of ObamaCare

“In court in July, only two of the three judges … asked questions. ‘Oral argument in front of the circuit went about as badly for the defenders of the [ACA] as it could have gone,’ says Nicholas Bagley, a professor of law at the University of Michigan.

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Specialty Drugs, Fiduciary Duties & The Hot Potato Method

October 13th, 2019

Specialty drugs can cost hundreds of thousands of dollars per member per year, or more. One new specialty drug approved this year costs +$2,000,000 for an annual treatment………

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Schuessler To Speak at The Texas Public Policy Foundation

October 12th, 2019

Carl Schuessler is set to speak at the upcoming Texas Public Policy Foundation event in January, 2020 in Austin, Texas. The panel discussion is on “The Way Out of America’s Broken Health Insurance System.” Knowing Carl as we do, his message may be “Grow Cojones For (a) Change.

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The Mother of All Health Care Battles Looms

October 11th, 2019

We have reached a tipping point in the battle against high cost health care. Employers have run out of money to pay for it. Employees can’t afford to use their health insurance anymore. Meanwhile hospitals continue to game the system with egregious charge-master pricing and their disco-discount game with their carrier partners. They have effectively dug their grave and are about to be pushed into it……………..

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Colorado Proposing To Adopt Reference Based Pricing Strategies

October 9th, 2019

Proposal will take Colorado down several relatively untraveled roads, potentially creating a health insurance market like no other in the country that could become a national model — or a cautionary tale……………..

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Introductions Are Worth Big Bucks In The Insurance Industry

October 6th, 2019

Earning commissions forever by simply making an introduction beats working for a living………….

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The Betalin Cure

October 6th, 2019

A team of Jerusalem-based researchers and entrepreneurs claim they have a cure for diabetes that could hit the market as early as within the next few years…………..The patient should never have to inject insulin into his body again………………

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AMPS Reports Record Growth In 2019

October 6th, 2019

AMPS saw significant growth in its large customer portfolio this year, including customers with upwards of 150,000 members. The growth from small to midsize to large customers reflects broad embrace by employers and health systems……………..

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Risk Tolerance & Reference Based Pricing Strategies

October 3rd, 2019

The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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Renting Medicare’s Provider Network

October 3rd, 2019

 An idea with bi-partisan support?

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Everyone Is Paying For Mary’s Deductible Because Mary Isn’t

October 3rd, 2019

Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….

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Dead Peasant Insurance

October 2nd, 2019

According to one source, Hartford Life Insurance estimated that one-quarter of all Fortune 500 companies have COLI policies, which cover the lives of about 5 million employees.

Can proceeds go to reduce GASB 45 ?

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Individual Coverage HRA – The Good, Bad & Ugly

October 2nd, 2019

SOURCE: Trucker Huss

“The chief advantage of offering an ICHRA as opposed to traditional employer-sponsored group health plan coverage is that it transfers much of the financial risk from the employer to the individual marketplace, thus allowing for more predictable costs for the employer from year to year…….

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Indiana Hospitals Under Scrutiny

September 30th, 2019

Indiana Jones (Michael Hicks) Sounds Alarm

“What I discovered will deeply anger every Hoosier and should embarrass most hospital administrators and board members. I also expect it to cause significant changes to state policy with respect to these hospitals. This is likely to change the way we tax them, regulate their competitors and enforce anti-trust laws. It will surely lead to civil litigation involving billions of dollars of excess profits.”

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PWC White Paper

September 30th, 2019
“There is a sense among employers that it is time to think creatively and broadly about changing the system. In 2020, medical cost trend will continue its march upward, but not without employers working to slow and perhaps even stop that march.”

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Hospitals & Insurers Fight Against Transparency

September 30th, 2019

Hospitals say price transparency won’t lower prices. So what will? 

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AMPS – RiskManagers Purchasing Coalition #1 Choice

September 29th, 2019

Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the self-insurance industry, announced a comprehensive cost containment solutions suite that will help self-funded employers significantly control healthcare costs in 2020……………..

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Government Approves New Group Health Plan

September 27th, 2019

A new government approved group health plan through which employees may purchase individual health insurance on the open market may have a significant impact in the employee benefits arena.

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American Greed Ushers In Single Payer Health Care

September 26th, 2019

Centers for Medicare & Medicaid Services Administrator Seema Verma warned insurers to shape up or face the consequences of “Medicare for All.” 

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Sleepy TRS Responds To El Paso’s Bold Move To Offer Commercial Health Plan

September 25th, 2019

“El Paso ISD found a novel way to migrate most of its staff out of the state’s program and onto a new local plan…………In response to El Paso’s decision and with the expectation that other districts may pursue a similar course of action, TRS is now looking into the possibility of regional options for school district employees.” Read the rest of this entry »

COBRA To The Rescue

September 25th, 2019

General Motors cuts health plan for 50,000 striking employees

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Revolutionary New Cancer Drug Approved

September 23rd, 2019

A “revolutionary” new class of cancer drug that can treat a wide range of tumours has been approved for use in Europe for the first time.

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We’re Live With CBS National News!

September 23rd, 2019

By Jeanne Pinder

We’re live with CBS national news! We’ve been promising big news for a while now, and here it is…….

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6 Degrees Health Discovers CASH IS KING

September 22nd, 2019

Cash payment claim strategies often saves more than what the plan would have otherwise paid proving providers will accept less reimbursement for cash………………..

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Freedom Health 100 – A New & Innovative Group Medical Plan

September 20th, 2019

Freedom Health 100 is proud to announce a new group health insurance product  – The Freedom Health 100 plan.

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Reinsurance To The Rescue!

September 20th, 2019

You never know who is behind the insurance curtain. You may think you have insurance with ABC Insurance Company,  but they may only be the “fronting” company retaining only a small portion of the risk. You might be insured with 20 or 30 carriers through a reinsurance treaty, each sharing in the risk on a prorata basis. 

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You’re Fired!

September 18th, 2019

You’re negotiation skills suck!

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Blue Cross Ripped Us Off!

September 14th, 2019

“They are using our money, so overpaying there is no consequence to them………So it is easier for them to pay the bills as they come in, whether they are appropriate or not……………..”

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Why Most Public School Districts Get An “F” In Health Care Management

September 13th, 2019

By Bill Rusteberg

School districts are entitlement based bastions whose decision making processes heavily weight social considerations at the expense of prudent business practices.

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How Hospitals Drive Up Health Costs

September 12th, 2019

Every senator, virtually every congressman and every mayor of every large city has a powerful hospital system in his or her district. And those hospitals are as politically untouchable as soybean growers in Iowa or oil producers in Texas.

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ERISA Health Plan Fiduciaries Defeat DOL’s Excessive Fee Claims

September 12th, 2019

Recent court decision is a reminder that health plan fees must be monitored and that a good fiduciary process is always the principal defense to claims of fiduciary imprudence.

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Why Would I Hire You?

September 12th, 2019

The job pays $65,000 per year plus benefits. By the time we add up all the benefits including health insurance, workers compensation, FICA, etc., your job is worth $85,000.

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Changing Logos

September 12th, 2019

By Bill Rusteberg

A favorite strategy to lower health care costs by plan sponsors is to change the logo on one’s I.D. card.  Everything else remains essentially the same.

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American Health Care is Broken, Especially in South Texas

September 11th, 2019

Brownsville and Harlingen in deep South Texas leads the country in the highest health care costs with a markup rate of 940% of Medicare, followed by three other nearby cities of McAllen, Edinburgh and Mission……………..

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The World Is Flat

September 11th, 2019

In the real market, healthcare costs are flat.” – Dave Chase.

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The Payer You Never Heard Of

September 8th, 2019

You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?”

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A Week In The Worst Health Care System In The World

September 8th, 2019

By MATTHEW HAHN, MD | POLICY |

What happens when you place an entire nation’s health care in the hands of an overly-controlling, ineffective government bureaucracy and huge corporations whose mission it is to squeeze as much money from the system, no matter the cost, including people’s lives? You get the carnage that is the American health care system.

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Healthcare Cost Trends Not Looking Good

September 7th, 2019

Medical trend continues to outpace general inflation. Those plan sponsors who abide by the law of civil obedience continue to fund the health care beast’s insatiable appetite while others are taking a different approach. The later have solved health care……….they have stopped feeding the beast…………

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How To Control Specialty Drug Costs

September 6th, 2019

By Molly Mulebriar

There is only one proven method to control specialty drug costs……… 

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The Balance Billing Myth

September 3rd, 2019

A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit. Balance billing occurs when you don’t ask the price……………

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Texas Files Suit Against Aliera Healthcare

September 1st, 2019

The State of Texas has filed a lawsuit seeking to stop Aliera Healthcare from selling health insurance in Texas and engaging in the business of insurance without a state license.

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The Rise of Indentured Servants In Health Care

August 31st, 2019

More than 50% of doctors are now in employee positions and generally beholden to “big medicine” so that doctors’ fidelity is primarily to the hospital system that employs them and away from patients.

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Mr. Sidgwick

August 30th, 2019

By Bill Rusteberg

Mr. Sidgwick: “Self insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this an essential health benefit under the ACA?”

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Restoring The American Dream

August 30th, 2019

For a free copy of Dave Chase’s best seller go here: healthrosetta.org/friends/

Region One Touts RGV School District’s Report Cards

August 28th, 2019

Great leadership, great students……………..

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BCBS of Texas Ordered to Pay $21 Million for “Willful Conduct of Fraud”

August 27th, 2019

A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital……

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Hiding Costs Behind A Co-Pay

August 27th, 2019

The law limits co-payments for a 30-day supply of the life-saving drug under private insurance plans to $100. It does not change the price of insulin…………………

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Blue Cross Blue Shield of Texas Validates Reference Based Pricing Strategies

August 26th, 2019

Blue Cross has successfully hijacked the term Reference Based Pricing  –  a damn smart marketing move……………………

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1st Year RBP Report Card

August 22nd, 2019

A mid-size Texas employer went from a BUCA to a Reference Based Pricing plan last year. The benefits remained the same. However, a change was made in the way providers are paid.  In lieu of paying through secretive managed care contracts, the plan paid medical providers based upon a transparent reimbursement schedule tied to a percentage of Medicare allowable charges.

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