Risk Managers – Thought Leadership on Health Insurance

Most Insured Individuals Use Relatively Little Health Care

The use of health care services — and the spending associated with those services — is far from evenly distributed across the population. It has long been known that a small portion of the population accounts for a disproportionately large share of health care spending, with 20 percent of the population typically accounting for
80 percent of total health care spending.

Mitigate Partners Is Worth A 10 Minute Call

The path of a prescription drug from the manufacturer to the patient is a long and winding road …” – Paragon Health Institute, 2026

Indemnity Health Insurance

What is an indemnity health plan?

An indemnity health plan will reimburse an enrollee for a portion of their healthcare costs, regardless of what medical provider the member uses or how much the provider bills.

How Three Communities Cut Healthcare Costs 20-50% and Redirected Savings Back to Employees

When Ashtabula reclaimed healthcare control, they saved $2.4M in year one with just 300 school district employees. That’s $8,000 per employee. The district went from dangerously low reserves to choosing how to spend their dividend: higher pay, better benefits, subsidized healthy food, restored programs.
Approximately $450 million annually flows out of Ashtabula County into distant corporate healthcare systems. A tremendous sum for a county of 100,000 people. That extraction weakens everything: wages, schools, economic opportunity, health outcomes.

Understanding IRS Section 501(r): What Employers and Employees Need to Know

Did You Know That 100,000,000 Americans Qualify For Free Care?

SOURCE: Memberly Benefits.

Healthcare costs can feel overwhelming for both individuals and employers. Fortunately, there are federal rules designed to ensure fairness in how nonprofit hospitals bill patients and provide financial assistance. One of the most important is IRS Section 501(r). Here’s a breakdown of what it is, how it works, and why it matters for employees, employers, and plan sponsors.

Meet Lesli Wood

Lesli Wood – Regional Vice President of Sales for Central/South Texas

She brings over 25 years of experience in the health benefits industry, with a proven track record in sales and account management at organizations such as Allied Benefit Systems and Humana. Her passion for building strong relationships and delivering exceptional service makes her a valuable addition to the Meritain Health Sales Team.

Highest Selling #Drug in America

“A full 2-year course of Keytruda can cost $385,000………………….”

Understanding the New Wave of ERISA Litigation Targeting Voluntary Benefit Plans

What Employers, Plan Fiduciaries and Brokers Need to Know

“These novel lawsuits challenging voluntary benefits are not only notable for what they allege, but also because they implicate consultants and brokers.”

100 Million People Qualify For Free Care

Meet The Bull

Dr. Bill “The Bull” Hennessey is a physician turned whistleblower who has spent decades exposing the fraud, waste, and abuse that cost Americans billions every year. Nicknamed “The Bull” for his aggressive, no-nonsense style, he has been featured on Dr. Phil, national TV networks, and investigative outlets, bringing hidden industry practices into the light.

Judi Health Unveils Launch of Advisory Firm, The Judi Group

stethoscope on red background with piggy bank — The Judi Group’s team will conduct “forensic-level” analyses across the vendors a plan sponsor works with to spot and remedy key issues, according to an announcement shared exclusively with Fierce Healthcare. (Kubra Cavus/GettyImages)

By Paige Minemyer Jan 20, 2026

Capital Rx A.J. Loiacono Employer-Sponsored Health Plan Healthcare Costs

Last fall, transparent pharmacy benefit manager Capital Rx rebranded as Judi Health in a bid to better reflect the breadth of the company’s portfolio.

Buying Loyalty

Carriers & TPAs Compete For Broker Loyalty

By Bill Rusteberg

Years ago when I was a commission driven insurance whore a TPA dropped by my office. “Bill, how many self-funded lives do you have on how many groups?” he asked. “Move 2,000 lives to us and we will not only pay you the same commissions you’re getting now but I will personally deliver a $250,000 check as our way of saying THANK YOU for the business!!”

Direct Provider Agreements

The sign of a good business deal is when both sides walk away happy……

By Bill Rusteberg

For mostly unreasonable reasons everyone wants access to provider agreements when seeking medical care. The term “In-Network” is forever imbedded in the American vernacular.

Aldeen’s Sunday Morning Bathroom Read – NSA Enforcement Dies

“Insurers will know that they can lowball their initial payment and then ignore a subsequent IDR award ordering them to pay more — and there will be nothing providers can do about it.”

Rx Rebates – Maximizing Revenue Through Deception

Hoodwinking – A Popular & Proven Sales Strategy

By Bill Rusteberg

The following illustrates two common practices in the insurance industry to maximize revenue through deception by hiding administrative fees and commissions on the claim side of the ledger with a little help from the PBM.

The Secret World of Stop Loss Insurance Pricing

By Daron Potts

Welcome to the self-funding jungle! Your client is at 60% of manual. They’ve run perfectly for three years. And their renewal is still going up. This is the pricing floor at work.

Illegal Aliens Cost Texas Hospitals Over $1 Billion in 2025

New data from the Texas Health and Human Services Commission surpasses earlier estimates.

President Trump Unveils The Great Healthcare Plan to Lower Costs and Deliver Money Directly to the People

The White House – January 15, 2026

President Donald J. Trump’s Great Healthcare Plan is a broad healthcare initiative that will slash prescription drug prices, reduce insurance premiums, hold big insurance companies accountable, and maximize price transparency in the American healthcare system.

TRS ActiveCare Out To Bid For 2026-2027 Plan Year

Award is expected to be made public in February 2026. Will Blue Cross retain the account? Or will Aetna win the Musical Chair competition against Blue Cross once again? Will United HealthCare win on a toss? Or will all three win, each awarded designated geographic areas where they have the best “discounts?”

No Deductibles? No Co-Pays? Is This Texas-Based Health Insurer Too Good to Be True?

SOURCE: Texas Monthly

Curative says it can turn profits without its customers facing the usual out-of-pocket costs or high premiums. Economists have their doubts.

Bobby Kennedy Willfully Violates HIPP Regulations

“He’s got incredible health. Dr. Oz looked at his medical records and……

90 Degree Benefits

90 Degree Benefits is a national third-party administrator (TPA) specializing in unique health plan solutions, including self-funding and level-funding. With more than 23 local offices across the U.S., our team provides the regional expertise brokers and employers need to take their health plan in the right direction.

Tx. HB. 4144 Expected To Turbocharge Critical Illness Sales

Texas has passed legislation gifting insurance brokers a golden opportunity to sell critical illness policies to Texas political subdivisions.

Ass National Insurance

A Cash Pay plan member goes to a medical provider. Since cash is accepted everywhere there’s no need for a network of “preferred providers.” The member is free to go anywhere and is universally viewed as a “preferred customer.”

Oh Oh

One For The History Books – Texas School District Paid $68,375 In Monthly Commissions To Health Insurance Agent

The La Joya Independent School District has a long history of generosity going back decades. Ruth Villarreal can attest to that. Generous servings from the district’s self-funded health plan honey pot have been a source of untold wealth for Ruth, a local insurance agent with connections.

$68,375.00 per month, for each month remaining on the original term of this agreement at the time of termination.
Continue reading One For The History Books – Texas School District Paid $68,375 In Monthly Commissions To Health Insurance Agent

Experience Freedom From Health Insurance

CrowdHealth is not an insurance company, but a platform & community that empowers you with a crowdfunding tool and a wealth of resources to efficiently manage your health care costs.

Republican President Mandates Government Price Fixing

Bernie Sanders rejoices at the news. “This is historic! The Republicans are finally coming around!”

The Real Reason Hospitals Are So Expensive

“Percentage of savings fees is the greatest fraud foisted upon consumers since Victor Lustig sold the Eiffel Tower in 1925. To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.”

Free Audit Lift Benefits Brokerage

(This post first appeared on this blog January 1, 2016)

A new company in town is shaking up local insurance brokers by offering to take a free look at what employers pay for benefits, to see if it can get them a better deal……………..

Competition breeds hostility in some people,” he said. “Bottom line: There aren’t any brokers who offer what we offer………….

Latest ERISA Cases from Schlichter Bogard Address Voluntary Benefits

The complaints allege breaches of fiduciary duty related to the premiums charged for accident, critical illness, cancer and hospital indemnity insurance.

Broker RFP Process Guide: How To Launch A Winning Benefits Broker RFP

By Bryan Davis – SOURCE: Nava Benefits.

Summary

A benefits broker request for proposal (RFP) can unlock crucial information about the employee benefits marketplace, your own total rewards offering, and the level of support your HR team could receive. But the RFP process can be time-consuming, confusing, and difficult — unless you’re well prepared. Here are four steps to get ready for a smooth RFP process.

United Airlines Let Their Broker Take 64 Cents Of Every Dollar Employees Spent On Insurance

By Dave Chase

United Airlines employees paid their broker 64 cents per premium dollar in year one. 64% went to Mercer as commission. Not to medical care. Not to claims. To the broker. Then it “improved” to 27% by 2023. Mysteriously dropped to 2% in 2024 when lawsuits started flying.

That’s not market pricing. That’s exploitation of weak oversight.

9,000 PPO Doctors Say “Adios”

9,000 physicians just walked out of Anthem’s network in New York.

What Took So Long? This Has Been Going On For Years!

By Dave Chase

For decades, benefits consultants operated under a simple protective claim: “We just advise.” Schlichter Bogard just demolished that defense & put them on a map no one wants to be on.

How To Stretch A 10 Second Decision To Infinity

A True Story By Molly Mulebriar

Take a ten second decision where everyone wins and nobody loses to a political subdivision then start your stop watch. You will be amazed how long a 10 second decision actually takes.

The Rise of ERISA Health Care Class Action Lawsuits

By Steve Ditto

Healthcare just crossed into its 401(k) moment. The law firm that forced fiduciary accountability into retirement plans has now filed healthcare ERISA class actions.

PBM Three Card Monte

By George H. George

Your PBM just charged your plan $2,847 for a prescription. They paid the pharmacy $340. They kept $2,507 as “spread.” You’ll never see it on your invoice.

No Surprises Act – Supreme Court Petitioned To Review Enforceability

Should the Supreme Court grant cert, the outcome of the case could have broad implications for the enforceability of NSA arbitration awards, a key feature of the NSA’s regulatory framework.

Private Practice Is Dead…..If You Take Insurance

“Here’s the truth, taking insurance can work but it’s very painful. You have to run a volume based practice, see lots of people and have complicated systems set up, for it to run well.”

Discrimination Runs Rampant In Legacy Health Insurance Plans

Illustration By Dutch Rojas – The Rojas Report

By Bill Rusteberg

Health insurance is a reimbursement benefit for a covered loss. Although plan members each pay the same premium, some receive greater benefits than others.

Do PBMs Know The Exact Amount of Rebates Per Prescription?

There’s been a discussion this week on Linkedin about whether PBMs can provide detailed quarterly rebate settlement accounting for plan sponsors.

RiskManagers 2025

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

100 Best Health Insurance Blogs and Websites in 2025 – RiskManagers.us ranked #10 in the 100 best health insurance blogs from thousands of blogs on the web ranked by relevancy, authority, social media followers & freshness.

Bette Nesmith

By Michael Magri

Dallas, Texas, 1954. Bette Nesmith was drowning. A divorced single mother raising her young son Michael on a secretary’s salary of $300 a month, she had dropped out of high school at seventeen.

Most Read RiskManagers.us Blog Article of 2025

Posted November 30, 2025 this blog entry has received +16,000 viewers, all in the past 60 days.

LBJ Signs Medicare Into Law – Was Ronald Reagan Right?

Medicare will be 60 yeas old July 2026. Was Ronald Reagan right?

City Gifts $2M to Local Hospital

City of Brownsville invests $2,000,000 in local hospital under Chapter 380 of the Texas Local Government Code.

The Myth of Nationalized Healthcare

The UK Health Care Disaster is a Cautionary Tale for America’s Rising Class of Armchair Socialists

The Washington Post shocked many of its Democratic readers this week by telling the truth about the growing disaster in the UK’s National Health Service — a cautionary tale as a few Republicans plan to join Democrats to extend the failed Obamacare subsidies rather than reform our own broken health care system.

A Surprising Treatment for Chronic Lower Back Pain: Cannabis

Two new drug trials find a THC-based cannabis extract could help with a condition that affects millions

6,240,000 Patients On Waiting List

There were 6.24 million individual patients waiting to get treatment in England as of October. That’s about 1 in 10 people in the country waiting in the queue.

Need Surgery But Don’t Have Insurance? No Problem………..

Pre-Existing Conditions Waived After 21 Days

Imagine needing some sort of surgical procedure but you don’t have insurance. No problem, book a flight to Costa Rica 21 days in advance, buy travel health insurance at the same time, and make your surgical appointment upon arrival at San Jose airport.

FLIGHT INSURANCE KIOSKS AND THE JET AGE

Travel Insurance Kiosks at Detroit’s Willow Run Airport, 1954. Part of the “Old News” collection at the Ann Arbor District Library.

SOURCE: FLIGHT INSURANCE KIOSKS AND THE JET AGE — Jet Age Art

While researching the fight insurance angle for my TGA (“Airport” movie) Ticket Package assembly, I discovered a rich, although brief history of airport flight insurance sales. It all started with the “Great Lakes Fidelity” Airline Trip Insurance Receipt I had to design, as a major component of the overall ticket package, as fans of the “Airport” movie or novel know.

Modifying the ACA Maximum-Out-Of-Pocket Mandate

There’s More Than One Way to Skin a Cat

By Bill Rusteberg

Under the Affordable Care Act (ACA) once a plan member meets their out-of-pocket annual maximum the phenomenon of moral hazard is fueled. When other people’s money are funding health care expenses there is no incentive to address cost and needs.

2026 Insurance Industry Predictions

The Year Constant Evolution Becomes Competitive Advantage

“The insurance industry stands at a defining moment in 2026 where legacy approaches no longer match the pace of change. Carriers face mounting pressure: cyber threats target their infrastructure, customers demand personalized products that evolve in real time, and converging risks—from climate volatility to AI liability—challenge traditional models.

Ronnie Lockwood

We invited a man into our home at Christmas and he stayed with us for 45 years

100 Best Health Insurance Blogs and Websites in 2025

#10. RiskManagers.us

RiskManagers.us ranked #10 in the 100 best health insurance blogs from thousands of blogs on the web ranked by relevancy, authority, social media followers & freshness.

Find Hospital Pricing In Seconds

Ask about pricing strategy, market rates and competitor contracts – explore the data yourself HERE.

These Are Your Problems If You’re Using Blue Cross

“If you have a BCBS plan, this is happening to you. It doesn’t matter what they promised in the RFP. It doesn’t matter what the glossy sales deck said. It doesn’t matter what they tell you in meetings. This document governs what actually happens to your claims. And once you read it, you’ll understand why fiduciaries should be very, VERY, uncomfortable.”

Hospital Demands Blue Cross Pay More Than 120% of Medicare

Hospital sues BCBS of Alabama over reimbursement amid bankruptcy

Breaking News: Oral Weygovy for $150/mo.

By Stacie Mays

Breaking news…Oral Wegovy was approved yesterday, with Lilly’s Zepbound expected to follow in the next few months. Both companies have agreed to sell the drugs direct-to-consumer for $150/month for the lowest dose.

Santa Carl

Carl Schuessler, Inventor of The Schuessler Stick™ On His Way To Work

Rare photo shows Santa Carl racing to work, bringing peace, joy and magical wonders to struggling plan sponsors all across the Fruited Plains this Christmas season.

100 Best Risk Management Blogs and Websites in 2025

The best Risk Management blogs from thousands of blogs on the web and ranked by relevancy, authority, social media followers & freshness.

Pet-USA™

75% of claims paid within 24 hours, 95% within one week. Rated best pet insurance on the market.

When Can Medicare Patients Pay Cash?

By David Holt – June 5, 2025

For providers who treat Medicare beneficiaries, the rules around accepting cash payments are anything but straightforward. While it may seem reasonable to allow a patient to pay out-of-pocket for convenience or privacy, federal law places strict limits on when that’s allowed.

Payment Infrastructure Modernization for Healthcare

The U.S. healthcare system wastes $200–350 billion annually on administrative friction—billing complexity, payment delays, prior authorization bureaucracy, and claims rework.

TRS ActiveCare Seeks TPA Services

TRS seeks a qualified vendor(s) to provide one or more of the following types of services: (1) TRS-ActiveCare Program enrollment administration and TRS-ActiveCare Program District Liaison Team services; (2) TRS-Care Program direct billing services; and/or (3) TRS-Care Program enrollment administration services.

The 2026 TRS ActiveCare Blitzkreig Continues

Grand Prairie Independent School District joins a growing list of Texas school districts wanting out of the health insurance business.

How To Solve The High Cost of Man-Made Health Care

By Bill Rusteberg

FORMULA: Defined Contribution + Indemnity Fee Schedule (Eliminate/outlaw % of billed or allowed charges) and presto, you get the American middle class back in play.

HOW THE AMERICAN HEALTHCARE SYSTEM BROKE & WHY NOBODY FIXED IT

PIM Health | Payment Infrastructure Modernization for Healthcare

The most important stakeholders in American healthcare are unhappy. That’s mainly an architecture failure, not policy…well, maybe some policies.

The Largest European Broker

Serving Clients All Over The World

Howden is a specialist insurance broker. We combine the strength of a global broker with the personal touch of a group with employee ownership at its heart.

Look Up Where Your Generic Prescription Drugs Were Made

SOURCE: ProPublica

The FDA won’t tell Americans where their generic drugs are made, so ProPublica did it instead. Use information on your prescription label to locate the factory and see inspection reports.

More Texas School Districts Throw In The Towel – Join TRS ActiveCare Government Health Plan

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

Santa’s Adverse Selection Elves have been busy this year. As many as 40 Texas school districts are reconsidering their risk management strategies and may join the TRS ActiveCare government health plan in 2026.

RiskManagers 2026 Fee Schedule

Over the years when meeting with prospects for the first time we were invariably asked “How much do you charge?” Instead of dancing around the subject as most in our industry seem inclined to do, we decided to publish our fee schedule for the world to marvel at. We’ve done that every year since, and we will continue to do that until we turn room temperature which we hope doesn’t happen any time soon.