TSHBP Risk Pool Goes Bye Bye

The TSHBP risk pool has been unsuccessful in turning around significant underwriting loses despite back-to-back annual rate increases and a cash call to the tune of millions of dollars.

TSHBP officials are “Throwing in the towel” while attempting to replace commissions at the same time by offering commercial health coverage on a stand-alone basis to each TSHBP member district.

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American Healthcare Finance Is Bullshit

Billed Charges = $2,341,142.50. PPO allowed amount = $1.872,530.66. Plan negotiated down to $531,818.53……………Proof that billed charges are bullshit and PPO discounts are bullshit too. The American healthcare finance system is bullshit controlled by bullies……………....

Does this possibly prove there is no such thing as a $1 Million claim?

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Marshall Allen: A Relentless Voice for the Little Guy

By Dave Chase – May 19, 2024

On Sunday, May 19, we lost an extraordinary man, Marshall Allen, a dedicated journalist and former member of the clergy, whose unwavering commitment to investigative journalism has left an indelible mark on the healthcare industry. His tireless work exposed the deep-seated issues within the healthcare system, shedding light on price gouging, sloppy billing, fraud, insurance denials, and unnecessary treatments that preyed on vulnerable Americans.

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Aldeen’s Sunday Morning Bathroom Read – The OMG Edition

By Doug Aldeen

Rand recently published its report ( Rand 5.0) that suggests hospitals, on average, markup their prices for commercial carriers at 254% of Medicare. The American Hospital Association in its press release, in typical fashion, takes organizations like Multiplan to task and asserts that Multiplan and its commercial carrier clients are somehow to blame.

Continue reading Aldeen’s Sunday Morning Bathroom Read – The OMG Edition

Miami ISD Considers Bolting From TSHBP In Favor of Curative Health

“We have received information from TSHBP that the yearly claims for the program were over budget and therefore a surcharge of $150 per employee for 10 months will be assessed.  Due to this, we are pursuing other health care options through a fully funded insurance program for our employees.  Currently, the best option is the Curative plan.” 

Continue reading Miami ISD Considers Bolting From TSHBP In Favor of Curative Health

Leveraging Risk Transfer Through The Federal Risk Adjustment / High Risk Pool Program

Hot Potato Risk Transfer Method

Self-funded health plans have traditionally ceded large and unexpected losses through insurance policies naming the plan sponsor as the insured. Under these policies plan sponsors are reimbursed for losses. Many have now discovered they can duplicate this risk transfer strategy through a more efficient and economical method by naming the plan member as the insured.

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Government Mandates Reference Based Pricing For Indians

“Tonto That Hospital Charged Me 4 Times More Than They Charged You!”

Dear Tonto,

“I am pleased to announce that on June 4 the Indian Health Service (IHS) and the Centers for Medicare & Medicaid Services (CMS) published the much anticipated final rule implementing “Medicare-like” payment rates. The “Medicare-like” payinent rate will constitute payment in fill1 to Medicare-participating hospitals that deliver services to American Indians and Alaska Natives…..” SOURCE: Tribal Leader Letter

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School District Alert: Beware of Health Insurance Cooperatives

Although the following article is 3 years old we may be seeing a similar debacle unfolding before our very own eyes in Texas in 2024……………

Dozens of school districts left scrambling to pay $11.6 million in debts, a financial shipwreck that raises concerns about such ventures, which are virtually unregulated……

Continue reading School District Alert: Beware of Health Insurance Cooperatives

Why Do Insurers & Hospitals Fight Over Prices?

Baylor Scott & White Health to Terminate Blue Cross Blue Shield Agreements in July

Why should health insurance companies negotiate lower prices with hospitals when, thanks to the federal government mandate known as the Minimum Loss Ratio, both get paid more through higher prices? A sign of a good business deal is when both sides walk away from the table happy.

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Free Medical Care Coming To All Houston ISD Campuses Next School Year

Article Referred By Lori Ramos

Houston ISD to offer free telehealth services to all campuses after expanding partnership with national provider

The program is funded through a combination of insurance and fees. Hazel Health will bill for services on behalf of students with health insurance through their parents. A portion of Hazel Health’s platform fees are used to offset any out-of-pocket expenses not covered by insurance. Students with no insurance receive free care too. Hazel Health verifies uninsured status after sign-up.

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Mexican Dogs Get Better Deals

A friend runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”

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An Open Letter To The Amarillo Independent School District

This Open Letter to the Amarillo Independent School District has far more implications than just a story about a West Texas public school district’s failed efforts to reign in rising health insurance costs. It’s a story about a malaise affecting elected officials under status quo influence where nothing changes.

Josh Butler, a local Amarillo taxpayer and nationally recognized health insurance expert writes an excellent piece that, quite frankly, is one of the best we’ve seen. His open letter is representative of the continuing failure of elected officials everywhere to control health care costs when it’s been proven by others they can.

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Confuse & Delay Is Always To The Advantage of The Incumbent

A risk pool of more than 20,000 member lives composed of an aggregation of Texas public school districts is looking for a home. The pool has suffered significant underwriting losses necessitating a mid-year cash call to the tune of millions of dollars to pay claims and cover expenses. A run on the bank appears imminent.

Continue reading Confuse & Delay Is Always To The Advantage of The Incumbent

Virtual Care Becoming A Highly Competitive Business Model

Modern Age Doctor Visit

We are seeing more companies entering the virtual care market supported by deep pocketed investors sensing lucrative opportunities in an emerging market.

This virtual care program connects users to a doctor in less than 60 seconds, 24/7/365. Enhances efficiency supporting early diagnosis and treatment while improving health outcomes and reducing healthcare costs.

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‘Houston Resident Charged Surprise $400 ‘Facility Fee’ After Doctor Visit

HOUSTON – Unexpected, unexplained fees are driving up the cost of doctor visits for families across Houston. We are talking hundreds of dollars in charges above your co-pay. They’re called “facility fees,” and patients are told days or weeks after their appointments they have to pay up.

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The Bubonic Plague of Risk Pools

By Jody Bright

In the world of risk pools such as Multiple Employer Trusts (METs), Multiple Employer Welfare Arrangements (MEWAs), Interlocal Governmental Agreements, and other risk cooperatives and even Captive Insurance Companies size is not the real magic. Yes, there are inherent benefits to size and creating opportunities to bring home greater savings are among these but without a differentiating risk strategy the risks could outweigh the advantages. 

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TSHBP Sends Warm Regards

Plan Update
April 29, 2024
Texas Schools Health Benefits Program (TSHBP)
  Dear TSHBP Member Districts;

We hope this message finds you well. We are writing to share an update with you for the Texas School Health Benefits Program (TSHBP). 

The TSHBP Board of Directors passed a resolution on April 24, 2024, to amend the time frame within which each member district must provide the appropriate notice of withdrawal from the TSHBP Program from 90 days (June 1st) to 75 days (June 15th). Districts that elect to participate in the options presented by the TSHBP, must notify the Program no later than June 15th of their election. Districts who wish not to participate in any of the options presented by the TSHBP must notify the Program no later than June 15th of their withdrawal.

It’s worth noting that in the event a member district decides to withdraw from the TSHBP Program, there is an obligation to continue honoring any payment commitments as outlined in Section XVII (Withdrawal) of the TSHBP Bylaws. This includes fulfilling the current additional contribution of $150 per employee per month, which remains applicable after September 1, 2024.

As mentioned in previous communications, the TSHBP will propose additional plan options for districts to review when they receive their renewal packet. We will begin delivery of these options on or before May 15th. The TSHBP will also schedule webinars after the options are delivered so that our member districts can attend and learn about each of the plan offerings before the decision date of June 15th

Please do not hesitate to reach out to us if you have any questions or need further clarification. We are here to assist you in any way we can.

    TSHBP Bylaws
 
Thank you for your dedication to our shared goals.

Warm regards,
The TSHBP Team  
Texas School Health Benefits Program
2175 North Glenville Drive
Richardson, TX 75082
www.tshbp.org  
“Isn’t Health Insurance Fun!”
Continue reading TSHBP Sends Warm Regards

FAIRCO

The explosive growth in self-funded insurance plans means that quality excess protection is more important than ever to your self-funded clients. FAIRCO has brought in-house and also partnered with trusted industry veterans to create a Medical Stop Loss solution that will meet your customer’s specific needs by offering a wide variety of options, contract periods and deductibles.

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Texas Health Insurer Makes “Cash Call” to Districts with May 1 Renewal Deadline

With the announcement to districts by the Texas Schools Health Benefits Program ( TSHBP) that member districts must pay an additional monies per employee per month (PEPM) that are enrolled in the program, many member districts are rethinking their membership in the program. Unfortunately, they may be up against an imminent deadline. TSHBP requires districts to tell them by May 1 if they wish to opt out of the program. 

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More Lloyds of London History By Miller

This photograph shows waiters at the entrance of the 1928 Lloyd’s building in 1932.

By Paul Miller

It was a year in which an unusual action regarding a wealthy man’s insurance policy went before the King’s Bench Division. Before starting on a proposed trip around the world, Charles Weyerhaeuser, aged 63, took out an insurance policy with underwriters at Lloyd’s for £82,000.

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Marpai Bolsters Sales Team

Marpai Bolsters Sales Team with World-Class Executives, Richard Brewer and Ben Utz

Source: Marpai, Inc. (Nasdaq: MRAI), 4/24/2024

TAMPA, FL — Marpai, Inc., an independent national Third-Party Administration (TPA) company transforming the $22 billion TPA market supporting self-funded employer health plans with affordable, intelligent, healthcare, today announced the strategic hiring of two industry-renowned salespeople, significantly strengthening its sales force with a focus on accelerating its growth trajectory. These appointments underscore Marpai’s commitment to accelerating growth and expanding its market reach.

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TRS ActiveCare Board of Trustees To Meet Next Week

Will commercially insured school districts be “pardoned” and allowed to rejoin the Texas government health plan?

The TRS ActiveCare Board of Trustees are set to meet May 2. It is about this time of year TRS officials announce the upcoming September 1 renewal for the Texas government health plan for Texas educators.

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