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.
Only in Texas
November 27th, 2020Patient 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………………….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
South Texas Consultant Sentenced to Prison for $1M Fraud
November 22nd, 2020
Brownsville Texas Native Makes Fortune In Insurance Business
November 22nd, 2020
Former high school coach makes fortune in the insurance industry……………………….
“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)
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
Insurance Consultant Wanted
November 19th, 2020
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
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.”
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.”
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.
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
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.
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……………………….
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…..
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.
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
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.
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.
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.
Free Market Medical Association
November 3rd, 2020
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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.
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.
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.”
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.
Redirect Health
October 21st, 2020$0 Copays & NO Deductibles……………………………………
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……………………
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.
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.
Dinosaurs Are Alive & Well
October 10th, 2020“I’ll Never Retire………………………………………”
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”
Dennis Burkholder & Box 13
October 6th, 2020
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.
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.”
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
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.
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.
Christus Health Plan
October 3rd, 2020
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.
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………………..
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.
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……………………………
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………………..
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…………….
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
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.”
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.
$1 Tele-Health Visit
September 27th, 2020
Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..
Imagine If There’s No PBMs – Its Easy If You Try
September 27th, 2020
September 26th, 2020
“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
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.
Dan Crenshaw’s Band of Brothers & Sisters Pledge Healthcare Reforms
September 25th, 2020Health Care:
We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.
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?
Supreme Court To Hear PPACA Challenge With or Without New Justice
September 24th, 2020Single 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?
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……………
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.
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.
Whoa…………………..
September 18th, 2020
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.
Emancipation Proclamation
September 14th, 2020
King Murray
September 13th, 2020Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!
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.
MGU Founded Aboard Love Boat
September 13th, 2020
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
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.
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.
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.
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
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?”
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…………….