School District Blasts Gallagher’s Greed In Health Plan Choice

December 3rd, 2021

“Unknown to the School Board, Gallagher had received secret insurance commissions over the years totaling millions of dollars.”

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Reason & Logic Applied To The Great Feardemic

December 3rd, 2021

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Socialism Applied To Underwriting

December 3rd, 2021

Consultant: Rate this without specialty drugs. We plan to exclude all specialty drugs.

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Jury Finds UnitedHealthcare and Affiliates Guilty of Oppression, Fraud and Malice

December 2nd, 2021

“United’s Shared Savings Program takes up to a 50% administrative fee on the difference between billed charges and United’s arbitrary payments. United often receives more money on their shared savings fee than they pay to the provider.” 

So, what else is new? This happens all the time. Most plan sponsors don’t know anything about this. Here is another example, Aetna’s shared savings of +9% (Weslaco ISD vs Aetna) And how about Oakland County vs BCBS? Cigna vs Anheiser Busch? There are hundreds of lawsuits over the years addressing this practice. – Bill Rusteberg

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AMA: Individualism & Meritocracy is Malignant & Genitic Screening Is Racist

December 1st, 2021

Doctors Warn New Medical School Guidance Would Lead to Unqualified Physicians and Unscientific Medicine

Accreditation guidelines call meritocracy ‘malignant,’ suggest genetic screening is racist

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A Cure for Type 1 Diabetes? For One Man, It Seems to Have Worked

November 27th, 2021

Frederick Banting Discovered Insulin in 1923

A new treatment that cures diabetes 1? That’s gonna be one hell of an expensive drug! Unless the spirit of Frederick Banting rises from the laboratory once again.

Frederick Banting was the man who discovered insulin – and gave it away for free (diabetescommunity.com)

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NOW YOU’S CAN’T LEAVE! Starring TRS ActiveCare

November 27th, 2021

This (TASB LEGAL – see link below) seems to be contrary to the general understanding many districts have that a TRS ActiveCare member district which opts to continue participation effective Sept.1 2022 may exit the program any year they choose after that. Instead, according to the document below, it appears they are locked in for five years.

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How Nonprofit Hospitals Get Away With The Biggest Rip Off In America

November 27th, 2021

SOURCE: www.medicaleconomics.com

“Nearly two-thirds of our nation’s 5,000 hospitals, or around 3,900, call themselves nonprofit, a designation that allows them to avoid paying taxes.”

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Three Risk Transfer Strategies No One Talks About

November 19th, 2021

With their financial backs to the wall what are plan sponsors to do these days in maintaining an affordable and usable health plan for their employees?

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How Drug Money From Sick People Really Works

November 19th, 2021

Rebates are commissions.

So Joe Sixpak goes to the pharmacy to fill his diabetes prescription drug. Between Joe and his insurance plan the pharmacy is paid $408. The pharmacy keeps $69. Where does the rest of it go? Read the rest of this entry »

New York Times Columnist Responsible For Spike in Cardiac Related Medical Encounters

November 19th, 2021

WARNING TO HEART PATIENTS!

A New York Times columnist issues proclamations leading to a significant spike in cardiac related medical encounters among it’s broad base of readers. Reader discretion is advised.

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The TRS ActiveCare Dating Game

November 18th, 2021

Who will she pick? Blue Cross #1, Blue Cross #2, or Blue Cross #3?

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RiskManagers.us Fees Increased Due To Rapid Inflation

November 17th, 2021

RiskManagers.us, a fee based insurance consultant, is raising fees upon contract renewal due to robust inflationary pressures. Cost increases include E&O policy premium increases, travel expenses and continued taxation amounting to +40% of revenue. Additional expenses include legal, accounting, and outside specialty consulting retainers paid to special practice experts.

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You Can Lead A Horse To Water…………………

November 16th, 2021

A Texas City Gone Politically Tone-Deaf

By Josh Butler

“Your attempts to raise taxes …..have been rejected, twice.  Turn your attention to your health plan.  It is the single most significant area of opportunity, but you are not taking advantage of it currently.  What will it take?”

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Prediction Comes True

November 15th, 2021

Prediction that COVID Has “Small Impact” in Health Insurance Carriers Becomes Reality

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Why Do We Continue Feeding The Beast?

November 15th, 2021

Source: Linkedin, Author Unknown

Stunning Graph. There’s no question this trend will continue. 20 of 20 years have an increase… We’re up 400% in that time frame.

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Meanwhile South of The Border – The Mexican Healthcare Solution

November 12th, 2021

The American solution to solving the uninsured problem was the Affordable Care Act. The Mexican solution is different.

Seguro Popular is Mexico’s solution to protect their uninsured population. It’s benefit structure is disease based. It’s cost basis is income based. No one is forced to participate and no one is penalized if they don’t.

Maybe we could learn something here as this seems to be a practical, common sense approach to universal healthcare.

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Veterans Day 2021

November 11th, 2021

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

The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.

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Ha! It’s None of Your Business!

November 10th, 2021

New broker disclosure rules taking effect 27 December 2021 have most health insurance brokers and consultants running scared. But reptiles earning undisclosed compensation off non-ERISA plans are resting easy. They believe the new disclosure rules don’t apply to them. Or do they?

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David vs Goliath

November 5th, 2021

How can a small school district get better benefits and lower costs than TRS ActiveCare with over 450,000 members?

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Texas SOL Law Limits Runout Liability

November 4th, 2021

Texas has a law requiring that health care service providers bill a patient no later than the first day of the 11th month after services were provided.

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Leveraging Behavioral Economics To Solve Health Care

November 4th, 2021

Free cash flow is created by attracting a disproportionate number of high claimants (the Super Utilisers) to enroll (spin-out) in alternate group coverage by offering them 100% medical coverage with zero out-of-pocket expenses. They voluntarily elect coverage*.

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New Broker / Consultant Compensation Disclosure Rule To Take Effect

November 3rd, 2021

The days on “Don’t Ask, Don’t Tell” is coming to an end 59 days from now…….

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How Montana Is Revolutionizing Healthcare—With Markets

October 31st, 2021

If direct pay models became commonplace, they would empower and liberate both patients and doctors and do more to bring down costs than other healthcare reforms.

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Mask Stupidity

October 30th, 2021

Masks don’t work so why wear them? For those of you still wearing your Obedience Mask, how many more years are you going to wear them? Forever?

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Found Money ? The Golden Goose WIMPER Plan

October 29th, 2021

Imagine being able to provide more employee benefits for free at no cost to either the employer or employee. Sounds too good to be true doesn’t it? Well…………..you might be surprised or…..you might not…………….

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Billionaire Investor Enters The Drug Business

October 26th, 2021

“Is This Cuban’s IPO? Buy, Buy, Buy Now!”

Billionaire Mark Cuban’s New Firm Seeks to Reduce Drug Costs

When it comes to lowering America’s notoriously high prescription drug prices, who better to haggle on your behalf than a loud-mouthed NBA team owner best known for bullying referees and hosting a reality TV show?

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PBMs Must “Spill The Beans” Under Texas Statute

October 26th, 2021

Now as a matter of public record you can find out more about your PBM’s revenue streams earned from pharmaceutical drug manufacturers under a Texas statute and TDI amendment to the Texas Insurance Code.

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San Antonio Walgreens Pharmacist Refuses to Fill Ivermectin Script…

October 25th, 2021

Pharmacist takes the stance “Father Knows Best.” Patient says “You’re Not My Father!”

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How The Amish Defeated Covid without Vaccines…

October 25th, 2021

Amish Covid — ‘No hospitalization, isolation or vaccines = herd immunity’

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Victor Manes Opines

October 25th, 2021

Victor Manes, MBA

I AM STUNNED…..I have been in the Hospital Administration/Healthcare Contracting world for 30 years and it amazes me how Health Systems are still trying to hold on to their 1980’s mentality of offering contracts at a % of billed charges.

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Walmart Increases Self-Funded Employer Access to Cost Effective Care

October 24th, 2021

Self-insured employers will have access to Walmart’s retail and specialty pharmacy services, prescription drugs, telehealth services, optical care, over the counter services, and community health centers.

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Your Doctor Is Waiting For You In The Parking Lot

October 24th, 2021

A healthcare system without waiting rooms…..

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TRS ActiveCare Competes for Business

October 23rd, 2021

For the first time in 20 years TRS ActiveCare is Competing For Business.

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Does TRS ActiveCare Non-Compete Agreement Trump Chapter 1501 of The Texas Insurance Code?

October 22nd, 2021

If a district requests a Blue Cross small group proposal is Blue Cross required to provide one or does the non-compete agreement preclude them from doing so?

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FBS & Higginbotham Join Forces To Capture Texas School Business

October 21st, 2021

Financial Benefit Services and Higginbotham Combine – Employee Benefits Firm in Richardson, Texas, Joins the State’s Largest Independent Insurance Firm

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Big Pharma & Plan Sponsors Are Co-Conspirators

October 21st, 2021

By Molly Mulebriar

Big Pharma is taking advantage of us because we let them.

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ICHRA’s Are Looking Better Every Day Thanks To The MHPAEA

October 20th, 2021

Employer Reacts To Punishing Government Mandates – Vows To Terminate Health Plan

With more punishing government mandates why in hell would an employer continue to put his business at risk by continuing a traditional group health insurance plan when he could simply offer a defined contribution plan allowing employees to pick and choose individual coverage on the open market? 

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Pig donates kidney to United States Congressman

October 20th, 2021

Amazing, breakthrough operation puts Congressman back into action……………

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You May Qualify For Free Hospital Care

October 19th, 2021

The Affordable Care Act (ACA), enacted into law on March 23, 2010, added Section 501(r) requirements to the Internal Revenue Code that a 501(c)(3) tax-exempt hospital must satisfy to maintain tax-exempt status. The financial assistance policy (FAP) is a requirement mandated by the ACA and implemented as part of the IRS. As per IRS 501(r), an FAP must apply to all medically necessary care provided by the hospital.

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Help Valley Baptist Hospital Fulfill Their Charitable Mission

October 19th, 2021

Give Me Your Poor, Your Tired, Your Huddled Masses…………..

“You may qualify for hospital financial assistance if your household income is below 350 percent of the federal poverty limit or if your annual out of pocket medical costs exceeded 10 percent of your household income in the past 12 months.”

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An Arm and a Leg’: Hello?

October 18th, 2021

The cost of money transfer under health insurance plans is +600% more than under a credit card transaction. Cash pay centric health plans cuts out all that wasted money……….

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October 17th, 2021

This agreement with Equity Healthcare marks another growth milestone for Centivo, which has now expanded into markets across the United States including Metro New York, Southern California, Central Florida, northern North Carolina, Nebraska, Iowa and Wisconsin.

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ASC Sues Aetna Over “Mystery Repricing Program”

October 16th, 2021

Aetna repriced $233,988 to $33,380. Inquisitive minds want to know why………….

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Surprise Medical Bills & Reference Based Pricing

October 15th, 2021

The old saying “The plan pays what it’s going to pay, nothing more and nothing less” will now have to necessarily say “The plan pays what an outside arbitrator says it will pay, nothing more and nothing less.”

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Claim Audit Exposes Managed Care Reimbursement Levels

October 14th, 2021

2016 audit of BCBSTX claims shows paid amounts for “emergent” services were in excess of ten times Medicare fees…….

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Today’s Primary Care Problems Can Be Solved by Advanced Primary Care

October 13th, 2021

Employers are ditching traditional care methods for Advanced Primary Care………….

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Former Insurance Commissioners Gets 7 Years In Prison

October 13th, 2021

Georgia’s former insurance commissioner was sentenced Tuesday to just over seven years in federal prison and ordered to pay restitution of $2.6 million on 37 counts of mail and wire fraud, money laundering, and aiding the filing of false tax returns.

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Why Pay For Health Insurance For Those That Don’t Need It?

October 12th, 2021

A Hidden Nugget In The Affordable Care Act

By Bill Rusteberg

A Plan Sponsor may be wise to consider a risk transfer strategy through a program created by the Affordable Care Act but which few plan sponsors are aware of.

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Predicate For Vaccine Mandate is False

October 12th, 2021

“If the proposed mandate cannot guarantee that the individual vaccine recipients are protected against breakthrough infection, nor prevent the spread of the infection to at-risk people (vaccinated or not), then the mandate is based on a false premise.”

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Attention: Hospitals & Their Attorneys Are Prohibited From Reading This Blog

October 11th, 2021

In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.

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Crack Healthcare Costs with Cash

October 11th, 2021

Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…

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Hospital Rejects 120% of Medicare, Accepts 105% Instead

October 11th, 2021

If a hospital rejects 120% of Medicare reimbursement and turns non-emergent patients away, why do you think the same hospital would accept 105% instead?

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MediShield

October 10th, 2021

An add-on service providing Reference Based Pricing legal support for possible balance bill escalations or litigation…………………

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RxPharmacy Assurance Launches Innovative Stop-Loss Supplement to Manage Pharmacy Risk

October 10th, 2021

A supplemental stop-loss product for unexpected and potentially catastrophic specialty drug claims? How’s that possible………………..?

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How A West Texan Turned A Small Pharmacy Into A National PBM

October 8th, 2021

Jerry Hodge had an opportunity and the vision it took to recognize it’s potential but he didn’t have the credit or the money to seize upon it.

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TPA Administrative Services Agreement

October 8th, 2021

By Bill Rusteberg

Yesterday we reviewed a TPA Administrative Services Agreement. It was same old same old until we got to page 13.

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Bureaucratic Red Tape Delays Compassionate Use Basis

October 8th, 2021

By Marty Makary MD

If we wanted to, we could instantly slash daily Covid death rates in HALF (or more) with one pill.

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The Great Money Grab

October 7th, 2021

Be Afraid, Very Afraid

By Molly Mulebriar

“You don’t want me to know your business because it won’t be good for you” said the physician group’s business manager some years ago.

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RBP Vendor Offers More For Less

October 7th, 2021

By Bill Rusteberg

As RBP grows so will the number of new entrants into the market with improved benefits and competitive pricing. That’s good for business.

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Why Are Carriers Dragging Claims These Days?

October 7th, 2021

Side note to the Kaiser article below brings two observations:

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Hospital System in Colorado to Refuse Organ Transplants to Those Without Covid Jab

October 6th, 2021

A hospital system in Colorado has now announced that they will be refusing organ transplants to all patients who haven’t received a vaccination against Covid-19.

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Texas Businessman Reacts To Government Vaccine Mandate

October 6th, 2021

The restaurant business is a tough business. Add to that onerous government mandates and it’s even tougher. But this restaurant owner has had enough……………….

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Chinese Flu Anti-Vax Punishment Ok’d by Government

October 6th, 2021

Government dictates employers can punish employees who refuse to take a Chinese Flu vaccination…………….

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Cash Beats Managed Care Plans Every Time

October 4th, 2021

Removing Financial Barriers To Health Care

This is how to remove all financial barriers to healthcare, improve benefits, and save money at the same time.

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What the Broker Compensation Disclosure Rule Means for Employers

October 4th, 2021

Undisclosed broker compensation can be enormous. Take the case of a Texas public school district in the Lower Rio Grande Valley who thought their broker was earning $126,000 in fees.

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Have You Read Your RBP Contract?

October 3rd, 2021

Stop! Don’t Sign Until You Read It!

Years ago a client signed a contract before we had the chance to review it. When we did we found the vendor was royally screwing the client with new terms and conditions not memorialized in their winning proposal.

I asked the owner who happened to be an attorney too, “Did you read the contract before you signed it?” He bowed up and said “Yes, of course I read the contract!” 

“Then why did you sign it?” I countered.

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Plan Sponsor Refuses Advice and Pays Dearly For It

October 3rd, 2021

Please, Oh Please, Take This Advice

By Bill Rusteberg

It’s sad how much drugs are costing these days. Most plan sponsors are simply “sucking it up” and paying for these abusively high and egregious prices funded by rate increases passed on, in part, to plan members.

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Texas Broker Captures 150 School Districts

October 2nd, 2021

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

The Texas Schools Health Benefits Program (TSHBP) is a commercial health insurance program developed for Texas school districts by FBS, a Dallas insurance brokerage.

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Wall Street’s Buying Up U.S. Health Care

October 2nd, 2021

What happens when Wall Street takes over health care? You may not realize it, but private equity firms — which invest money for wealthy individuals, pension funds and endowments — are buying up medical practices and hospitals all over the U.S., expecting a big return on their money.

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Health Care Profits For Me, But Not For Thee

October 1st, 2021

Companies and lobbying groups often paint their business foes as the primary problems with the health care system……………..

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More Americans Can’t Afford Drugs Anymore

September 30th, 2021

“Drug Prices Are Too Damn High”

The most recent West Health and Gallup survey reports that 7% of U.S. adults were unable to pay for at least one prescription medication between March and June of 2021.

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Sad Story With Happy Ending

September 30th, 2021

When Warner saw that his insurance company paid nearly $17,000 toward the $54,000 charge for a covid test, he first thought: “At least I’m not liable for anything”

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Innovative Risk Sharing Strategy You’ve (probably) Never Heard Of…………

September 29th, 2021

“Granular Insurance places self-funded employers on a path of certainty with its multi-year rate and benefit guarantee: a meaningful cap on annual premium increases with moderate and predictable changes to an employers’ spec.”

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RBP PPO Wrap For $1.50 PEPM

September 28th, 2021

Rental PPO Competitor Reacts To The News

We’ve learned there is a national PPO network active in all 50 states that works as a wrap to  RBP plans for an access fee of $1.50 PEPM. This network is Medicare based and has negotiated direct provider agreements at less than 200% of Medicare.

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