“Prudent plan fiduciaries will establish and adhere to a formal, written policy to ensure compliance with the New Disclosure Rule. Indemnification and limitation of liability provisions in service provider contracts should also be revisited relative to this new rule.”
Texas School District Wins “Highest Cost Health Insurance” Award
July 4th, 2022
Eagle Pass Independent School District has got to be paying more for health insurance than any other school district in Texas…………………..
Aldeen’s Sunday Morning Bathroom Read – Happy July 4 Edition
July 4th, 2022
By Doug Aldeen
Sunday morning bathroom read (Happy 4th of July): Slowly but surely (more like a glacial pace) the python like grip of the industrial medical sick complex is loosening… .
Elected Official Mad As Hell – Hospital Cartel Crushing Middle Class
July 4th, 2022
“Some things are worth getting mad about. The hospital cartel is using taxpayer dollars to help crush the middle class and rob lower-income families of upward mobility…………Wealthy hospitals took billions of taxpayer dollars meant to protect struggling hospitals — and then some billed poor families or even sued patients.” – State Treasurer Dale R. Folwell, CPA
Bella, Erec and Lotta
July 3rd, 2022
Dogs are “superior smellers” and are already used to detect what the human nose typically cannot from diseases, such as Parkinson’s, cancer and diabetes, to drugs and explosives in public places, according to the American Lung Association.
Free Health Care Por Los Mojados
July 3rd, 2022
California will become the first state to remove immigration status as a barrier to health care, making all low-income illegals eligible for state-subsidized healthcare regardless of age.
Dr. Banting Patented Insulin Over 100 Years Ago For $1. What Happened?
July 3rd, 2022
4 Out Of 5 Americans With Diabetes Went Into Debt To Pay For Insulin, New Survey Shows
By Deb Gordon
Amidst rising inflation, Americans are feeling the squeeze of higher prices on everything from gas to groceries. But when inflation bumps into the already rising cost of drugs such as insulin, the impact can be serious and the stakes are high.
More Plan Sponsors Eye The Canadian Connection
July 2nd, 2022
“What! I thought It was The French Connection!”
A county government in New York has been accessing Canadian prescription drugs through their self-funded health plan since 2004 with savings in the millions of dollars. Now we see more employers considering the same by moving away from traditional Predatory Business Models (PBM’s) as drug prices reach unaffordable levels in this country.
Searching For The Perfect TPA
July 2nd, 2022
We are looking for the perfect TPA. Some of the qualifications are memorialized here: Selecting a Third Party Administrator.
Predatory Business Model (PBM) – The Case of The Missing 40%
July 2nd, 2022
Holms & Watson Remain Stumped
SOURCE: Vitori Health
A report by the PBM Accountability Project reveals the details of PBMs’ “evolving business models and revenue.” Despite the available financial data, the authors could not identify “the source of nearly 40% of PBMs’ total gross profit.”
Which Drug Would You Buy?
July 1st, 2022
The Tale of Two Underwriters
July 1st, 2022
By Bill Rusteberg
“What color is that orange?” asks the first underwriter. “It’s yellow!” says the second underwriter. “It can’t be! It’s an orange!” responds the first.
AAA – Solution To High Cost Ambulance Service?
June 30th, 2022
How many more renewal increases, deductible adjustments, or narrow network offerings till you decide enough is enough⁉️
Canadian Prescription Drugs Provide Savings For Health Plans
June 29th, 2022
ATTENTION EMPLOYERS: Do you have anyone in your health plan who is costing big dollars due to high-cost prescription drugs? The same drug may be significantly less expensive in Canada.
MEDSAVE MANAGEMENT LLC assists self-funded plan sponsors towards obtaining Canadian prescription drugs for plan members.
American Hospital Association Issues Fact Sheet on Reference Based Pricing
June 29th, 2022
Some employers are moving away from offering traditional coverage with a provider network and instead are using reference-based pricing for some or all of services they cover.
States Move Ahead With Canadian Drug Importation
June 29th, 2022
Boiled Alive
June 28th, 2022
Article Referred By Brent Evans
There was once a frog who had been captured by his country and put in a cage. As he was a very scared and naive frog, he believed it when told it was for his own good.
Canadian Prescription Drug Importation Program
June 28th, 2022
How it Works
- We select a Canadian pharmaceutical manufacturer and negotiate with the manufacturer and the seller.
- Rx is imported to the United States where we test and relabel the product, transport it to a warehouse, and store it securely.
- Your state agency orders the Rx from us, and we prepare, ship, and deliver the order.
Employers May Have To Pay More in 2022
June 28th, 2022
Employers may have to pay more in 2022. but here’s a solution………
For plan years beginning in 2022, coverage is considered affordable if an employee’s required contribution for self-only coverage does not exceed 9.61% of the employee’s household income.
Blue Cross: You Can Check Out Anytime You Like But You Can Never Leave
June 28th, 2022The Bottom Line: Brokers earn bonuses, vacations to keep companies from switching from Blue Cross
Lawyers Have Field Day With Dobbs vs Jackson
June 28th, 2022
Put two lawyers in a room and they will come out with three different opinions………….
Does Your Rx Plan Cover RU-486?
June 27th, 2022
RU-48 was developed in 1980 and came into use in France in 1987. It became available in the United States in 2000. It is on the World Health Organization’s List of Essential Medicines.
TRS ActiveCare Touts “FREE” Specialty Drug Benefit
June 27th, 2022Feel-good email brings great news for plan members but threatens plan finances…..
New York State Set To Enter Medical Tourism Business
June 26th, 2022
New York Announces Special Medical Tourism Package Designed For Pregnant People…………
Buying Down An Aggregate Corridor
June 26th, 2022
Realizing the decision to purchase will be based on worst case scenario, a broker can deliver the lowest bid every time if he knows how.
Send This Man To Rehab! Will Insurance Cover It?
June 24th, 2022
We need to know if he’s high. Has he been doing bong hits, blasting rails, chasing the dragon, and/or dropping acid? Is he hopped up on goofballs?
Former Insurance Worker Becomes A Mermaid
June 24th, 2022
“The former insurance company worker described the experience of gliding under water, half-human and half-fish, as “meditation in motion.”
Governor Says “Who, Me?”
June 24th, 2022
Who, Me? Nope I Didn’t Do It!
New Jersey Governor says he didn’t intervene in insurer dispute
Cash Pay Health Plans Make Sense
June 23rd, 2022
Cash Pay Level Funded Plan Make Sense
Combining level-funded plans with locked-in cash-pay rates for medical procedures purchased prior to treatment creates an innovative cost containment network strategy for employers.
Amarillo Drug Dealer Makes It Big
June 23rd, 2022
Amarillo Drug Dealer Earns Billions
Little did anyone imagine a drug dealer in West Texas (you can’t get there from here) would turn into a billion dollar business. It all started with a $21,000 loan from a loving mother.
Watch This Case Study Webinar
June 22nd, 2022
“Please take the time to watch this compelling case study webinar that showcases what is possible when an employer takes a truly proactive approach to controlling the cost of healthcare claims” – Dan Meylan
Texas Based Study On NSA Arbitration Cases Raises Questions
June 22nd, 2022
Texas-based study raises questions about impact of using additional criteria in No Surprises Act arbitration cases
Weird Insurance Company Names Cropping Up Everywhere!
June 22nd, 2022
Gun Bill Includes Extension Allowing Kickbacks to Insurer’s PBMs
June 22nd, 2022
SOURCE: Howard A Green, MD – Linkedin
Can’t make this shit up. US Congress sneaks into the current gun bill an extension allowing continued kickbacks to insurers pharmaceutical benefit managers screwing patients and their physicians.
Lawyers Get Sued Too
June 22nd, 2022
Lawyers Professional Liability Insurance
Zurich’s Lawyers Professional Liability Insurance Program offers Professional Liability/Errors and Omissions coverage to the following segments of attorneys: Law firms with attorney count of up to 100 attorneys; solo attorneys; part time attorneys and moonlighting attorneys.
Davita Stock Price Plummets – 10k Report Reveals Fears
June 22nd, 2022
Davita Locations
Certain payors have been attempting to design and implement plans by limiting the number of in-network providers, setting arbitrary provider reimbursement rates,……….
Dialysis Limited Benefits Doesn’t Violate Medicare Secondary Payer Statute
June 21st, 2022
“The question in this case is whether a group health plan that provides limited benefits for outpatient dialysis — but does so uniformly for all plan participants — violates the Medicare Secondary Payer statute. We agree with petitioner Marietta and the United States as amicus curiae that the answer is no.
Bankrupt Status-Quo Health Plan Eyes Cost-Shifting Remedies
June 20th, 2022
“There is no excuse for this! Poor risk management, old style remedies and believing in magic is a recipe for disaster!” – Don Pedro
Cassie Brown
June 20th, 2022
Insurance Commissioner Cassie Brown
Cassie Brown was appointed to serve as Texas insurance commissioner by Governor Greg Abbott in September 2021. She is the chief executive of the Texas Department of Insurance (TDI), overseeing the regulation of the third largest insurance market in the nation and the eighth largest in the world. The agency regulates approximately 2,800 companies and more than 700,000 agents and adjusters.
100 Million People in U.S. Saddled With Health Care Debt
June 20th, 2022
6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.
PBMs Could Be Driving Up Plan Sponsors’ Drug Costs
June 20th, 2022
In June 2016, only two months after the contract term began, an individual’s claim for an erectile dysfunction compound medication totaled $405,325.43 over three months Read the rest of this entry »
Proposal to Import Drugs Creates Unusual Alliance in the Senate
June 20th, 2022
By Victoria Knight
Harmony is not often found between two of the most boisterous senators on Capitol Hill, Bernie Sanders (I-Vt.) and Rand… Read More
Bill Smart
June 19th, 2022William Jackson Smart was a twice-married, twice-widowed Civil War veteran and father of 14 children……….
Summer Session 2022
June 19th, 2022
A Public Purchasing Seminar – June 22, 23, 24, 2022 – Designed for Public Purchasing Professionals with special emphasis on the latest developments that are essential in public purchasing.
Free Hospital Care For The Uninsured!
June 19th, 2022
Attorney General Bonta Issues Consumer Alert Following Reports of Hospitals Failing to Inform Patients of Options for Free or Reduced-Price Medical Care
“Only dumb people pay for health insurance in California” – Molly Mulebriar
5 Steps to Providing Better Employee Health Coverage: $0 Premium, $0 Copay, $0 Deductible
June 19th, 2022 
“Great turnout at TASB Summer Leadership Institute in San Antonio! My presentation was standing room only and about 20 Board Members were listening from the hallway. I’m excited to see so many districts ready to join this movement. Thousands more school employees will have access to affordable health coverage next year.” – Ben Clinton
Goose Insurance – Historic Change in Product Distribution
June 18th, 2022
“Our current system of distribution through independent agents in their brick-and-mortar offices will be largely replaced with digital distribution channels like Goose and Lemonade Insurance startups. That’s the future and the future is now” – Bill Rusteberg
Attention Plan Sponsors – Stake Your Claim To $485 Million Rx Settlement
June 17th, 2022
Ranbaxy exploited the FDA’s “abbreviated new drug applications” (ANDAs) in order to secure valuable first-to-file generic status and lucrative 180-day exclusivity that comes with the first-to-file status.
New Sales Opportunity For California P&C Agents
June 17th, 2022
How many Californians have guns? Whatever that number is, a proposed government mandate requiring liability insurance will bring fast and easy bucks to aspiring P&C agents. “George, you own a gun?” is the opening line sales pitch……………”Then you have to buy this policy or go to jail!” is the closing line………………”Sign here!”
AMPS Offers Solutions For Hospital Sponsored Health Plans
June 16th, 2022
Advanced Medical Pricing Solutions (AMPS) offers the consultancy experience, external contacts and integrated solutions you need to make it possible…………..
Texas Shuts Down Unlicensed Insurer – 65,000 Policyholders Affected
June 16th, 2022
TDI orders unlicensed insurer, Salvasen Health, to wind down operations in Texas
The Texas Department of Insurance (TDI) issued a consent order (PDF) today requiring Houston-based operation Salvasen Health to stop selling unauthorized health insurance and begin an orderly shutdown.
Does Free Cafeteria Plan Administration Constitute Rebating?
June 15th, 2022
Cafeteria Plan Administrators offering “Free” administration services in return for selling insurance products earn commissions on insurance policies sold to plan members. Nothing wrong with that, sounds like a good deal. But are there any regulatory issues?
Employers – It’s Time To Help Hospitals Achieve Their Charitable Mission!
June 15th, 2022
Give Me Your Poor, Your Tired, Your Huddled Employee Masses…………..You may be surprised by how many of your employees are eligible for free hospital care!
Clueless City Struggles With Health Care Costs
June 14th, 2022
KEY TAKEAWAYS:
- Top two rated insurance consultants replaced with the bottom two ranked consultants proving it pays to be last
Texas MedClinic Acquired By Community Health Partners
June 13th, 2022
Dr. Bernard Swift, founder and CEO of Texas MedClinic
Texas MedClinic sold to larger private equity-backed network. The company announced the sale of 20 urgent care clinics to national operator Community Care Partners.
Go Farther Gasoline
June 13th, 2022
A tankful of Go Farther Gasoline would sure go a long way towards easing the pain at the pump these days…………………..
Hospitals Fined The Equivalent of Two Hospital Admissions
June 13th, 2022
“Don’t worry, it’s only a scratch. We’ll make it up on the next one or two hospital admissions”
U.S. LawShield – Legal Defense Protection for Gun Owners
June 13th, 2022
Texas Man Wins Arms Salesman of The Year
There is no other arms salesman on the entire planet even close to what this Gun Salesman of The Year has achieved! He has sold more guns in less time than anyone else in history. His secret sauce? Reverse psychology selling – “Hell, yes, we’re going to take your AR-15, your AK-47…..”
Tesla Insurance
June 13th, 2022
Community Care Partners
June 12th, 2022
Community Care Partners is a physician owned and managed group of urgent care and primary care clinics serving patients across the United States under the brands Nova Health, SouthStar, Coastal and BestMed Urgent Care.
Yottaflow Offers Instant Online Stop Loss Quotes
June 12th, 2022
MyHealthGuide Source: Yottaflow, 6/7/2022
CLEVELAND — Yottaflow is excited to announce brokers and TPAs can now obtain illustrative stop loss quotes instantly from Yottaflow’s quoting partners.
Aldeen’s Sunday Morning Bathroom Read
June 12th, 2022
By Doug Aldeen, Attorney at Law
Lawyers are the fourth branch of government: If you cannot legislate or regulate it, litigate it.
Geico To Pay $5,000,000 For Car Sex?
June 11th, 2022
Car insurer Geico may have to pay $5m after woman contracts STI in a vehicle………..
Howden Acquires TigerRisk
June 9th, 2022
Howden acquires TigerRisk, creating “much-needed” fourth global reinsurance broker
Everything You Need To Know About Writing Professional Liability Insurance in 30 Minutes
June 9th, 2022
Any business that gives advice needs professional liability coverage including insurance agents and consultants active in health care…………………..
What Does The Future of Healthcare Look Like?
June 8th, 2022
The world of medicine is changing faster than ever, with new treatments and technologies being discovered all the time. The Medicine 2042 conference, taking place between June 8-9 in Tel Aviv envisions the future of medicine and science, and what that might look like in the year 2042 and beyond.
Pay Your Hospital Bill with Salt Water
June 7th, 2022
“You have provided me with a surprise medical bill. I am providing you a surprise medical payment …………..”
Wholesale Brokerage Expands Texas Footprint
June 7th, 2022
The MGU unit acts as an underwriting manager for various insurance companies for which it primarily underwrites ICOA insurance, Texas Non-Subscriber and related insurance products.
I Don’t Have Time To Choose The Right Vendor!
June 7th, 2022
Shortlister – An HR vendor selection community that helps empowered, data-driven technology buyers to find and choose the right vendor.
Dostarlimab
June 6th, 2022
18 rectal cancer patients were given dostarlimab every three weeks for six months and ended up cancer-free………………………….“I believe this is the first time this has happened in the history of cancer………”
Another Virtual Healthcare Offering Hits Market
June 5th, 2022
Benefits include unlimited virtual visits with $0 copay and $0 deductibles, capacity to treat over 1,500 conditions, the ability to prescribe medications and write orders for labs, x-rays and other diagnostic tests………………….Dedicated physician, $1 drugs………….
Backstory On This Whole Rx Rebate Fandango
June 4th, 2022
As Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean……………..
Amber’s Homeowners Insurance Policy To The Rescue?
June 4th, 2022
“While legal experts say using homeowner’s insurance policies is common in defamation cases, Virginia lawyer Jeremiah Denton told The Post that most policies have a clause that stipulates judgment costs will not be covered.”
Obamacare Premiums Set to Spike By 53%
June 4th, 2022
“What turned the Joker into Joker was losing his government-subsidized mental health care. His whole life went to shit because the government made him dependent and then pulled the rug out from under him.”
Radion Health
June 2nd, 2022
A 400 life case can be underwritten without claims experience or individual health questions? That’s interesting………….Is experience rating becoming a thing of the past? Read the rest of this entry »