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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How to Get Around ERISA Anti-Assignment Provisions

August 22nd, 2019

“There are three possible ways for providers to avoid application of the anti-assignment provisions in plan documents.

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Texas School District Lowers Healthcare Costs While Improving the Quality of Care

August 22nd, 2019

“Managing health care on a local level brings needed accountability to health care financing while providing improved access to care and higher patient satisfaction. The patient-physician relationship becomes more than just a ten-minute office visit; it becomes a true partnership.”  – Alex Zuniga

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Beginning of The End of Group Health Insurance?

August 20th, 2019

Will HRA’s replace group medical plans?

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$0 Investment Brings $2.4 Million Annual Return

August 19th, 2019

Is it true a South Texas Hospital system is buying up primary care practices to fatten up their cash cow?

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The ‘follow-up appointment’

August 18th, 2019

For many people in medical debt, a trip to the emergency room leads to the courtroom


Wenzle Hufford, 76, uses a rope to tow his wife, Lucynda, with his motorized wheelchair in Kennett, Mo. Both have large medical debts. His legs were damaged when he was hit by a car; she has diabetes and heart problems. (Michael S. Williamson/The Washington Post)

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The Misconception of Risk Pooling

August 17th, 2019

By Bill Rusteberg

As members of the +400,000 member TRS ActiveCare risk pool “The Power of Large Numbers” and “Economies of Scale” bring comfort to small Texas school districts . “We could not get comparable coverage on our own, much less at affordable rates” is the mind thought of school district officials throughout the state.

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San Antonio Suspends Paid Sick Leave Law

August 16th, 2019

“San Antonio has agreed to delay implementation until December 1, 2019. The stay will allow time for guidance from the Texas Supreme Court on the law’s constitutionality. In the meantime, San Antonio’s Paid Sick Leave Commission has agreed to work with business stakeholders to recommend changes in the ordinance to the San Antonio City Council.”

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Hospital Bills 1661% of Medicare

August 16th, 2019

Hospital billed charges total 1661% of Medicare. A typical PPO “discount” would be between the range of 50-70%. If the later, the hospital would be paid about 498% of Medicare. Plan paid 180% of Medicare. Hospital still wants more money. Plan sponsor says “Not in my lifetime!”

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The Cost of Convenience

August 16th, 2019

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

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Selecting a Third Party Administrator

August 16th, 2019

By William Rusteberg

With the growing suggestion that the BUCAs are inflexible third party administrators unwilling and unable to administer Reference Based Pricing plans and other strategies in the market today, more brokers are seeking new partnerships with independent third party administrators (TPA). An independent TPA can offer much more than a traditional carrier model.

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August 15th, 2019
“Those trying the preserve the wildly under-performing and bankruptcy-inducing status quo healthcare system will do whatever it takes to try to thwart progress” – Dave Chase

Why Some Doctors Purposely Misdiagnose Patients

August 15th, 2019

In his time at the hospital, from 1999 to 2007, his salary rose from$185,000 to $300,000, and he qualified for bonuses up to $220,000 if he met certain billing targets.

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Off The Record

August 15th, 2019

By Bill Rusteberg

While visiting Washington DC last year on business, I ended each day with a short visit to Off The Record, a bar located at the Hay Adams Hotel across the street from the White House. This place is always packed with interesting people and I had occasion to meet a few of them. 

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August 14th, 2019

Texas and Colorado issue cease and desist orders to health care sharing ministry………

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Hospital Administrator Morphs Into Insurance Sales

August 14th, 2019

See hospital administrator morph into an insurance broker before your very own eyes…………….From Hospital administrator to power broker in under five minutes…..

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Health Insurance Choices Could Get Your Client Deported

August 14th, 2019

New immigration regulations leave coverage purchased with ACA subsidies off the list of positives.

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Brownsville ISD Insurance Commttee

August 13th, 2019

If you are a new era health insurance consultant this video will drive you nuts.

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To Save Money, American Patients And Surgeons Meet In Cancun

August 13th, 2019

A knee replacement surgery costs an average of about $30,000 at U.S. hospitals, but only $11,000 at Galenia Hospital in Cancun, Mexico.

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North Carolina Caves – Hospitals Win Big

August 11th, 2019

“By spending millions of dollars to oppose us and by using cartel-like tactics, these organizations were able to convince most hospitals to boycott the State Health Plan,” said Treasurer Folwell. “If big hospitals could do this to their largest customer, just think what they can do to the individual average citizen or business.

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Private Payers Pay 2.7 Times on Average What Medicare Pays Hospitals

August 11th, 2019

With the lid ajar on Pandora’s box, we are likely to see employer demands pegged to price transparency and more strategies built on provider prices.

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The Phia Group Launches Newest Service: Patient Defender

August 11th, 2019

Health plans, TPAs, and brokers can now contain costs while knowing that patients have a legal advocate standing by.

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Recent Health Plan Practices That Are Resulting in Underpayments to Providers

August 10th, 2019

“Anthem is determining whether an outpatient MRI, CT scan, or PET scan is “medically necessary” based on where the service is performed.”

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Do Hospitals Charge More to Make Up for Low Government Pay?

August 9th, 2019

Answer: “NO”. Hospitals charge as much as they can get away with…..

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Risk Payment Models

August 9th, 2019

Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses………………..

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Health Care Is Gobbling Up Your Wages

August 8th, 2019

SOURCE: Axios

“In 1999, the average health insurance coverage for a family consumed 14% of the average household income …  By 2017, family coverage absorbed more than double that amount, to about 31% of take-home pay.

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