In June, the HRA Council released its 2023 data report on the state of Health Reimbursement Arrangements, including Qualified Small Employer HRAs (QSEHRAs) and Individual Coverage HRAs (ICHRAs). The report shows that between 2022 and 2023, the number of American workers offered insurance through an ICHRA tripled; QSEHRA offerings, only available to small employers with less than 50 employees, doubled.
The Federal Food Drug and Cosmetic Act (FDCA) Section 804 permits importation of prescription drugs from Canada by a pharmacist or wholesaler, provided the drugs meet certain minimum standards, will pose no additional risk to the public’s health and safety, and results in a significant reduction in costs to consumers. HHS can approve a program if these conditions are met.
The Centers for Medicare & Medicaid Services’ (CMS’) Center for Consumer Information & Insurance Oversight (CCIIO) publishes the Individual Coverage Health Reimbursement Arrangement (ICHRA) Employer Lowest Cost Silver Plan (LCSP) Premium Look-up Table to help stakeholders access individual market Qualified Health Plans (QHPs) LCSP premium data by geographic location.
An Affordable Care Act mechanism intended to help small companies support ACA health insurance for workers is now being used by large companies to satisfy their ACA obligation to provide insurance to employees, under a Trump-induced loophole. They’re saving money, and selling it as enhancing choice.
The markup on drugs is phenomenal. Sensing a new business opportunity, RiskManagers has entered the pharmaceutical business as a self-declared Tylenol wholesale distributor serving hospitals across the Fruited Plains.
On December 3 every year, Cuban doctors celebrate their professional holiday. National Doctor’s Day in Cuba was established to commemorate the birthday of Carlos Juan Finlay, a Cuban physician and epidemiologist who was the first to discover the transmission vector of yellow fever.
ATTN. PLAN MEMBERS – Carry In Your Wallet or Purse At All Times
“Plan members (and the Plan) are completely indemnified against balance billing…….AMI Indemnity, an indemnity captive completely protects the plan and participant from additional legal or financial risk associated with a balance bill.”
Double network revenue turbocharges profits for the non-profits?
“In recent years, BCBS plans opened medical clinics that exclusively serve their members. Premera Blue Cross partnered with Seattle-based Kinwell Medical Group in 2022 to open primary care clinics for its members in Washington state.”
I recently got an interesting email from the clinic manager at a private psychiatry office. She has been reading Never Pay the First Bill and wanted to allow her insured patients to pay cash when the cash price was lower than their insurance company discounts. But she worried her insurance company contracts prevented it.
Expands current balance billing prohibitions to include ground ambulance services. Rather than applying the independent dispute resolution process, SB 2476 directs TDI to create an emergency service provider balance billing rate database. Health plans must reimburse ground ambulance services at:
Despite a history of fraud, one family has thrived in the regulatory no man’s land of health care sharing ministries, where insurance commissioners can’t investigate, federal agencies turn a blind eye and prosecutors reach paltry settlements.
“It’s no longer viable to go it alone and administrative requirements from insurance companies are time-consuming and burdensome. That’s killing things. It’s just so incredibly complex” – Allen Ditto, M.D.
Where else can you get free or almost free health insurance these days? Third party intermediaries like HealthSherpa, Milliman, Nexben, Take Command Health and many others provide enrollment assistance to help make that happen……………
Plan Sponsor Reacts To Lawsuit Brought By Employee Johnny Sixpak
“If you currently participate in [company name]’s Healthcare Plan, you may have a legal claim. Are you a current [company name] employee who has participated in the company’s healthcare plan? You may have a legal claim — and we’d like to speak with you. Contact our office today for a no-obligation, confidential consultation. At Schlichter Bogard, we protect whistleblowers.
Selling health insurance is a tough business. It’s not a created sale, it’s a replacement sale which means relationships must be destroyed before any chance of a sale is possible. Destroying relationships takes time, effort and money.
Why not give your employees a choice of up to 86 different ACA approved plans through four (or more)different brand name insurance companies (instead of just one as you have now) while limiting your contributions to whatever your budget allows on a per employee per month basis?
Watch the Ednburg Independent Insurance Committee learn (1) Their Rx spend is up 26.3% over last year, from $162.79 to $203.21 pepm, (2) International Rx sourcing could save over $600,000 on just one drug alone (Ozempic) and (3) Why Independent claim audits aren’t necessary because “Blue Cross audits every single claim.…..you’re only paying 29.6% of allowed charges.” NOTE: “Allowed Charges” are not billed charges.
Entrepreneur Max Kauderer thinks the company he has co-founded, a third-party administrator called Yuzu Health, can disrupt major insurance companies by helping offer small businesses more affordable health plans for its employees.
Department of Labor Settles Cross-Plan Offsetting Case
Cross-plan offsetting refers to the practice by which a health plan insurer or TPA recoups alleged overpayments to a healthcare provider under one plan by reducing subsequent payments owed to the same provider or plan participants under a different plan.
Minnesota, by simply removing the burden from the patient to the facility to establish eligibility under its financial assistance policy, is the market equivalent of Julius Caesar crossing the Rubicon.
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
I knew little of my father’s participation in WW2 until after he died. Unlike veterans of today his generation didn’t talk much about it. Their quiet pride was enough, understood by all.The following recounts the Battle of Hatten in which my father was a participant. – Bill Rusteberg
We created a new healthcare company specifically for small businesses in Texas. We built it because small business owners want to provide health coverage so they can do right by their employees. And employees want to protect their families.
“We now have 7 clinics in the RGV; 8 by the end of 2023; Weslaco, Pharr, McAllen (2), Harlingen, Brownsville, Raymondville and Edinburg by year-end. We employ 34 medical professionals with a plan to hire an additional 20+ by year-end. 18 months ago we had 1,500 members and today we have nearly 10,000 under contract.”
Most districts exiting the government health plan have failed while others have achieved unusual success. What makes the difference?
By Bill Rusteberg
It’s that time of year again when districts across the state are considering their health insurance options. Do they continue with TRS ActiveCare (TRSAC) or seek coverage on the commercial market? They have until December 31 to make their decision.
Starting as a 21 year old pharmaceutical sales rep. in Waco, Texas on a $17,000 a month “use it or lose it” expense account, this former drug pusher talks about his experience in the pharmaceutical industry, insurance companies and it’s effects on primary care physicians.
TRS ActiveCare member districts wanting out of the government program can simply stop paying premiums at any time. However, the TRS ActiveCare Paper Tiger reserves unspecified “remedies” to punish wayward districts.