Only in Texas

November 27th, 2020

Texas is the only state in the Union where the majority of Texas businesses can elect to non-subscribe. Thanks to our historical fore fathers, this option has been available since 1913.

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Patient Describes Experience At Methodist – San Antonio

November 25th, 2020
When I asked what the total billed charge for the procedure was going to be, that completely flummoxed them………………….

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Chapter 4: Health Care is Stealing Millennials’ Future, But They Will Take it Back

November 24th, 2020

“Most health plans have merely lipsticked pigs or paved cowpaths rather than rethought health plans for the modern era.” – Dave Chase

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South Texas Consultant Sentenced to Prison for $1M Fraud

November 22nd, 2020

Beware of Insurance Consultants Dress In Orange…………………

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Brownsville Texas Native Makes Fortune In Insurance Business

November 22nd, 2020

Former high school coach makes fortune in the insurance industry……………………….

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“How I Made Millions Off Texas Taxpayers” by Elijah Granger

November 21st, 2020

Texas school superintendent’s $2.25 million buyout threatens district’s finances………………..(Pssst…file this under Poor Risk Managment)

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TRS ActiveCare Alternative Programs: Does it Make Sense for Your District?

November 20th, 2020

Rising Health Insurance Rates………..Cost Shifting To Plan Members……………Less Choice

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Insurance Consultant Wanted

November 19th, 2020

GROUP HEALTH, DENTAL & EMPLOYEE BENEFITS INSURANCE CONSULTING SERVICES

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Let’s Screw 153,000 Young Healthy Workers

November 19th, 2020

CalPERS approved steep rate hikes for its cheapest health insurance plans Tuesday in an effort to save its most expensive plans from collapse…………….price hikes of up to 51% for health plans favored by young, healthy workers

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Amazon Launches Rx Delivery Service

November 19th, 2020

  Retail Pharmacist Reacts To The News

“Members could save up to 80 percent on generics and 40 percent on brand-name medications when paying without insurance, according to Amazon.”

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TRS ActiveCare Fights Back

November 18th, 2020

Is your school district considering offering self-funded health plans to your employees? This document outlines things to consider when making this decision.”

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Will Texas Finally Grow Some Cojones?

November 18th, 2020

The upcoming Texas legislative biennial session is fast approaching and lawmakers will have to address an historic $4.6 billion budget shortfall. “Tell all departments to be prepared to cut their budgets another 5%”  dominates the Austin rumor mill these days. 

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Sidecare Health – Health Insurance That Makes Sense

November 17th, 2020

An innovative and disruptive model designed to turn the industry on its head……….model has been shown to reduce health costs for their members by up to 40%…………members can customize the coverage to their individual needs…………..3 year rate guarantee in certain states…………Insured by

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Employers Eye ICHRA’s

November 16th, 2020

Individual coverage health reimbursement arrangements (ICHRAs), a new employer-sponsored health care benefit program for active employees that became available this year, are drawing the attention of U.S. employers, particularly wholesale and retail employers and those in education and the public sector.

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Is It Essential or Not Essential? It Can’t Be Both…………..

November 12th, 2020

He saved the ACA in 2012 by declaring the individual mandate essential to the survival of Act and then may save the ACA again in 2020 by declaring that the individual mandate is not essential to the survival of the Act……………………….

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City Escapes PPO Cult – Abetted By Renegade Hospital

November 12th, 2020

City terminates UHC and enters into direct contract with local hospital system for significant savings…..

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Veterans Day 2020

November 11th, 2020

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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Full Legal Representation for RBP Plan Members For $4.55 PEPM

November 9th, 2020

TRADITIONAL REFERENCE BASED PRICING VENDOR REACTS TO NEWS

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

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More Small Businesses Turn To Level Funded Plans

November 9th, 2020

Premiums can be 20% to 25% less for level funded plans than comparable community-rated plans………….An employer’s savings depend on the health of its employees and their families because an LFP plan is underwritten only for the specific employer’s employee population and not for a broader community.

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WebTPA to Join GuideWell’s Family of Companies

November 8th, 2020

MyHealthGuide Source: GuideWell Mutual Holding Corporation via PRNewswire, 11/6/2020

JACKSONVILLE, FL — GuideWell Mutual Holding Corporation (GuideWell), the parent to a family of forward-thinking companies focused on transforming health care, announced that they have signed a definitive agreement to acquire WebTPA, an innovative and market leading administrator of self-funded employer health plans.

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Bennett School District Reduces Health Care Cost by 50% With Better Benefits

November 3rd, 2020

SOURCE: Excerpt from Dave Chase ( Chapter 1: The Future of Health Will Be Local, Open and Independent – Relocalizing Health)

Bryan Perry, and direct primary care veteran, Clint Flanagan, have teamed up to serve employers such as the Bennett School District to reduce spending by ~50% while improving benefits.

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Free Market Medical Association

November 3rd, 2020
Austin Chapter • November Meeting
We hope you are keeping well, and keeping your distance.
Please join us for a virtual chapter meeting…
Wednesday, November 11 11:30am-1:00pm
The Zoom invitation is below. You can open this invitation in a browser window, or directly from the Zoom app on your computer or device.
We will discuss updates on meetings and general information about the free market.
We are graciously requesting each member invite at least one person, either a Provider or Purchaser you think would benefit from FMMA membership.
Examples would be:
  • employer you know, especially self-insured
  • interested provider
  • broker/consultant
  • local govt HR purchaser or even politician/policy maker
It is mutually beneficial for all of us to share in growing the chapter and the movement.
We look forward to seeing you … Thank you.
FMMA is inviting you to a scheduled Zoom meeting.
Topic: FMMA November Meeting
Join Zoom Meeting
https://zoom.us/j/3760214824?pwd=elpMRnBMbDMxVUpiZFJ1VFNTZlhGZz09
Meeting ID: 376 021 4824
Passcode: 5T7kH2
One tap mobile
+13462487799,,3760214824#,,,,,,0#,,414684# US (Houston)
+12532158782,,3760214824#,,,,,,0#,,414684# US (Tacoma)
Dial by your location
    +1 346 248 7799 US (Houston)
    +1 253 215 8782 US (Tacoma)
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    +1 929 205 6099 US (New York)
    +1 301 715 8592 US (Germantown)
    +1 312 626 6799 US (Chicago)
Meeting ID: 376 021 4824
Passcode: 414684
Find your local number: https://zoom.us/u/abKr4oWCeA
Cheers…
FMMA Austin

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Medicare-For-All May Gain Legs Today

November 3rd, 2020

Today’s election is historic…………………..and may fundamentally change health care financing…………… Read the rest of this entry »

Transparency Rule Mandates Employers Provide Internet Based Cost Information

November 2nd, 2020

SOURCE: HR Policy Association

“The final rule requires employers to have their third-party administrators publicly disclose detailed health care pricing data. It also mandates that employers make available to health plan participants an internet-based self-service tool that provides price and personalized out-of-pocket cost information.

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Hospitals Claim Pricing Transparency Will Increase HealthCare Costs

November 2nd, 2020

SOURCE: Health Affairs Blog

“Insurer stakeholders quickly panned the new rule, arguing that it is unnecessary and will lead to higher (not lower) health care prices.

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Insurance Broker Offers COVID-19 Health Coverage For Athletes

October 29th, 2020

I was stunned,” said Fairly, CEO of The Fairly Group in Amarillo, Texas. “It was the first time in my 25 years that a program which was agreed and bound was nixed 12 hours before it was to go live.”

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October 28th, 2020

Important AG Opinion Requested. Re: Self-funded RBP Plans

October 23rd, 2020

The Texas Attorney General has been asked to determine whether the Texas Business & Commerce Code prohibits a consumer reporting agency from reporting certain information if a member is covered through a self-funded reference-based-pricing health & welfare plan.

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Redirect Health

October 21st, 2020

$0 Copays & NO Deductibles……………………………………

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Chase Announces Third and Latest Book Release

October 16th, 2020

I wrote this book to empower every individual — and to help everyone recognize that despite yet another season of campaign promises, we do not need to wait on our legislators in Washington D.C. to change health care……………………

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A Picture Is Worth 1,000 Words

October 13th, 2020

This graph represents the dynamics characteristic of traditional managed care plans (PPO). PPO contracts are tied to the billed charges, not costs. As billed charges go up each year, so do premiums, even though costs may have not gone up at all. Employers mitigate their increasing costs by reducing benefits. It’s a vicious never ending cycle.

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Shoot Out At The OK Corral

October 10th, 2020

The Shoot Out At The OK Corral is an entertaining novella worth watching. Three insurance consultants vie for the business, each giving a 15 minute presentation to the Board of Trustees at the Kingsville Independent School District last week.

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Dinosaurs Are Alive & Well

October 10th, 2020

“I’ll Never Retire………………………………………”

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West Texas School District Who Refused To Be Bullied

October 9th, 2020

“The intent of this notice is to make you aware that we don’t recognize in any of these programs and Baptist Health will not agree to accept unilateral rates established by these reference based pricing plans…………..plan participants may be held financially responsible for up to 100% of billed charges”

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Dennis Burkholder & Box 13

October 6th, 2020

Dennis was a witness to Texas history that few know about……………….

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Hard To Argue Against Common Sense, Reason & Logic

October 6th, 2020

“Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the flu.

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How Insurance Brokers Are Augmenting Their Value Proposition

October 6th, 2020

“We see a lot of brokers making significant efforts to pull in better loss information and better claims information so they can be partners in risk with their customers, in terms of explaining to them the patterns they see, benchmarking them against peers, and then being able to say: ‘If you do this, this, and this, your total cost of risk might in fact go down, and could go down significantly.”

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Butler Says It’s Not The Doctors Fault

October 5th, 2020

“It’s not the doctors, or the nurses, or the people that actually work,” said Butler. “It’s the system. It’s the billing system that they all operate under.” – Josh Butler

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Show Down At The OK Corral

October 4th, 2020

Kingsville ISD went to bid for an insurance consultant to assist the district in managing their self-funded health plan. Staff made a recommendation to award the bid but the board decided to table action pending a public workshop. Three insurance consultants are bidding for the job.

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Stop Loss Market Update

October 4th, 2020

Specialty drug approvals, emerging gene therapies, less relevant PPO discounts, double digit higher charge master rates in 2021, more aggressive billing practices and COBRA provisions related to the pandemic will impact rates well into the coming year.

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Christus Health Plan

October 3rd, 2020

Open enrollment is November 1, 2020, and ends December 15, 2020.

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TDI Commissioner Resigns

October 3rd, 2020

Kent Sullivan has notified Governor Abbott that he will resign as Texas Insurance Commissioner in September to return to the private sector.

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Texas Governor Announces Agreement With Health Insurers

October 3rd, 2020

Governor Greg Abbott today announced that Texas’ major health insurers have agreed to continue reimbursing network health care providers for telehealth appointments at the same rate which they pay for office visits through the end of 2020………………..

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Low Bid Gets The Business

October 2nd, 2020

A recent post on this blog, Low Bid Gets The Business, described the Kingsville ISD’s search for an insurance consultant.

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Insurance Provider Announces Preferred Partner Compensation

October 1st, 2020

Holy Smoke! Insurance brokers can do much better with this compensation schedule ……………up to +3.5% better than current average commission levels……………………………

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Innovative Solutions Are Changing Health Care

October 1st, 2020
Only when the pain of higher costs exceeds the fears of change will common sense, reason and logic guide healthcare strategies………………..

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Stop Loss Claim Nightmare

September 30th, 2020

Busy Jill – She Had 18 Children In Less Than 10 Years

Not too many plan sponsors have ever conducted health plan dependent eligibility audits leaving them at risk of stop loss claim denials. If Little Johnny is the covered employee’s nephew, with the same last name, has a stop loss claim you can rest assured the stop loss carrier will determine they are not at risk leaving the plan sponsor eating the entire claim……………A ticking time bomb waiting to happen…………….

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DART – Dallas Area Rapid Transit RFP for Pharmacy Benefits Consultant

September 29th, 2020

Dallas Area Rapid Transit is a transit agency serving the Dallas–Fort Worth metroplex of Texas. It operates buses, light rail, commuter rail, and high-occupancy vehicle lanes in Dallas and twelve of its suburbs. Wikipedia

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Small Business Stabilization Program by United Advantage

September 28th, 2020

First Financial Targets Texas School Districts

September 28th, 2020

“First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools.”

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Is Opopira on Your Rx Formulary?

September 28th, 2020

Twin brothers invented Opopira, considered a miracle drug back in the day, a pasty mass consisting of a drug mixed with sugar and water or honey suitable for oral administration. This complex compound drug was used to treat diverse maladies including paralysis. 

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$1 Tele-Health Visit

September 27th, 2020

Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..

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Imagine If There’s No PBMs – Its Easy If You Try

September 27th, 2020

Once upon a time there was no such thing as a PBM…………………….

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September 26th, 2020

“Healthcare is the only expense line item in which all employees receive an unlimited budget…and also no training in how to spend it. That’s why they sign up for $2500 procedures when a $75 solution would do the trick.”  – Dave Chase

“Hiding Cost of Healthcare an ‘Insult to Americans”

September 26th, 2020

 “When the patient gets the bill, it looks like the insurer haggled on their behalf. Yet the final charge is still much higher than it should have been. The patient loses, while the insurer and provider win.” – Nikki Haley

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Free Rx

September 26th, 2020

Trolling the internet on Chinese Flu quarantine day # 267 (and counting) we came across a website touting “Free Rx.” As we suspected, it was just another third party intermediary offering to assist consumers in applying for Rx manufacturer assistance programs. For a fee of course.

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Dan Crenshaw’s Band of Brothers & Sisters Pledge Healthcare Reforms

September 25th, 2020

Health Care:

We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.

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TRS ActiveCare Enrollment / Financial Projections

September 24th, 2020

What are the statistics for TRS plan year 2020-2021? How many employees have moved over to heretofore illegal, competing commercial health plans and away from the state sponsored TRS ActiveCare government plan? What is the financial impact?

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Supreme Court To Hear PPACA Challenge With or Without New Justice

September 24th, 2020

Single payer system by 2028? Will Republicans embrace Obama Care as the better of two evils? Will whatever the Supreme Court decides have little effect on political realities?

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Charlie Meets The Tyler Rose & He’s Glad He Did………….

September 23rd, 2020

After talking with The Tyler (Grow Some Balls) Rose, Charlie was convinced he could achieve his goal of creating a better health plan — one his 150 employees deserved……………

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Dave Chase Announces Newest Book Release

September 23rd, 2020

I’ve been hard at work on something I’m very proud of: a roadmap for communities, large and small, to restore hope, health and well-being.

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Low Bid Gets The Business

September 22nd, 2020

Beginning an initial dialog with “How much will you charge us” is never a good indication things will go well with your chances of gaining a new client as long as pricing is the driving consideration.

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Whoa…………………..

September 18th, 2020

RAND stokes hospital pricing transparency fire with new report

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10 Most Common Procedures in ASCs

September 18th, 2020

Angie Stewart – Friday, January 10th, 2020

Eye and gastroenterology procedures are some of the most common services proliferated in ASCs, according to a March 2019 report by the Medicare Payment Advisory Commission.

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Emancipation Proclamation

September 14th, 2020

Freedom from high drug prices…………………………………..

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King Murray

September 13th, 2020

Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!

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Ballot Box, Courtrooms & Smoke Filled Rooms

September 13th, 2020

The future of healthcare will be decided via the ballot box, court rooms, and congressional halls.

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MGU Founded Aboard Love Boat

September 13th, 2020

Love Boat Cruise Spawns MGU……………………………

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Another Austin Insurance Insurance Startup Raises $20,800,000

September 13th, 2020

Austin Startup Sana Benefits Raises $20.8M to Provides Self-funded Health Insurance to Small Businesses

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Austin Insurance Startup Raises $10,000,000

September 13th, 2020

Austin-based health insurance startup Decent has raised $10 million as it looks to expand statewide.

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Managing The Cost of Risk vs. Insurance Brokerage

September 7th, 2020

For Fairly, the real story – and challenge– is not about insurance markets; rather it is about risk management.

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Meet Bind – Health Insurance For Companies

September 5th, 2020

With Bind, costs and choices are transparent and easy to compare. There is no deductible or coinsurance to meet before the plan starts contributing, and members can change and shape their coverage as their health needs change.

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Reduce Healthcare Costs by Offering a ‘Free’ Option

September 5th, 2020

If you had a group of employees traveling on a business trip and you told them they’d only need to pay a $100 contribution toward the hotel room, what’s to stop them from choosing a Ritz Carlton over a Days Inn? Both provide a decent night’s sleep, but one will cost you, the employer, a significant amount more.

This is what manufacturing firms are doing now with their benefit plans

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Aetna Touts Cheap “I-35 Discount Providers”

September 4th, 2020

Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.

“Holy Smoke guys, we’ve singled out our cheapest providers,  much cheaper than all the others,  20% cheaper! We call it the  I-35 Performance Network.” says the Aetna rep.

“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”

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The 50% Club

September 3rd, 2020

“I Was Raised To Pay My Debts On Time…………..”

Members of the 50% Club subscribe to the Upside Down Economics of Health Care. They understand those who pay on time are screwing themselves and those that don’t are rewarded…………….

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