US Risk Launches MedTour Pro for Employers


Dallas, TX (PressExposure) February 20, 2009 — U.S. Risk Underwriters, a subsidiary of U.S. Risk Insurance Group, Inc. (, the fifth largest managing general agency in the nation, announced the launch of a new professional liability product for the medical tourism industry called MedTour Pro for Employers.

MedTour Pro for Employers is designed for companies who provide freedom of choice to their employees, including an option to obtain medical services outside of the United States. Coverage is for damages caused by any actual or alleged negligent act, error or omission by the insured while providing options for medical tourism services.

“We are the first to market with a product specifically designed for employers,” said Art Seifert, President of U.S. Risk Underwriters. “MedTour Pro for Employers enhances our suite of products designed specifically to cover the risks inherent in the dynamic new industry, predicted to generate $100 billion in revenue by 2012.”

Currently the only provider of Professional Liability for medical tourism facilitators and for employers, U.S. Risk is on the cutting edge in providing important coverage for this rapidly growing industry. Its travel and complications coverage for medical tourists is tough to beat.

MedTour Pro for Employers is written with an A.M. Best “A” rated carrier on a claims-made basis. Limits are offered up at $1 million with a minimum premium of $5,000. Excess over the $1 million limit is available.
Agents and brokers should contact Lorna Greenwood at 1-800-232-5830 or

About U.S. Risk Underwriters, Inc.

About U.S. Risk Insurance Group

U. S. Risk Insurance Group, Inc. ( is a specialty lines underwriting manager and wholesale broker headquartered in Dallas. Operating 11 domestic and international branches, it offers a broad range of products and services through its affiliate companies, which include U.S. Risk Underwriters, U.S. Risk Brokers, Lighthouse Underwriters, LLC, Boston Insurance Brokerage, Inc., Professional Claims Managers, Omnisure Consulting Group, NCG Professional Risks Ltd. (London), and NovaPro Risk Solutions, LP.

Health Reform Insights – Predictions by Fred Hunt


SPBA Email Alert – December 28, 2009

Health Reform Insights & Talking Points 

By SPBA President Fred Hunt

I feel like the weatherman being asked to give a specific forecast of the weather a few years from today.  My forecast is below, but let me save your sanity by first explaining what will be playing out when/if a bill passes.   As I pointed out in my last e-mail, there are about 100 factors and processes which can change what you think you see ….even when/if the law is passed, and we all sit with printed copies in front of us and experts analyzing the actual words.

An example arose today.  A year ago, the Defense Authorization Act included what seemed like iron-clad wording that would ease and extend government medical care for wounded soldiers.  It was crystal clear.  However, a year later, the Defense Department has “interpreted” the law to deny many veterans the health services they thought the law promised, especially for Post-Traumatic Stress Disorder (PTSD).  The new interpretation decided to limit care only for things that can be proved to have happened during “armed conflict” in combat zones. This move is a blatant way to avoid paying for an expensive group of veterans and leave them uninsured or a burden on employer plans. (This is also yet another lesson for those who think government health care is embracing & caring.)

I mention this new development for two reasons:  First, as a heads-up that if this new interpretation stands, your plans may find that costs attributable to PTSD which everyone thought were covered by the clearly-stated law and Congressional intent may well apply to people who left the service after the Oct. 14, 2008 date of the Chu memo which arbitrarily changed the impact of the law. (No need for action yet, since there is an uproar of veterans groups demanding Congress return to its promise.)

My other reason for mentioning this news is that it shows how something you read in any final health reform law can have a very different real-world impact.  There is already some conniving going on behind closed doors in Congress to pull off some of these.  So, don’t drive yourself nuts to get the final language, and then assume that what you see is what you get.

The actual language of any bill will have hidden zingers.  Then, the Congressional staff draft what is called “the blue book”, which are essentially notes to give reg-writers background and “Congressional intent”.  The blue book often pictures things differently or with added pieces that you don’t see in the legislative language.  Then come the interpretations which the applicable upper-level Agency officials decide to make (like the Defense Department example).  Then come the nitty-gritty interpretations as the actual reg-writers create the regs with which we must comply.   Zingers can sometimes take a decade to emerge.   (If you are growling about the people who influence these interpretations, let me point out that  everyone who has attended an SPBA Spring Meeting has shaped law & policy effectively and constructively, and SPBA acts as a reality-check truth squad whenever possible in the rest of the process.  Please mark your calendar for the SPBA Spring Meeting April 14-16, 2010 in Washington DC to again steer policies towards common sense.)

So, it is fine to check the Library of Congress official legislative website at   as often as you want.  You can also read and hear all the interpretations, but the absolute specifics of how things would work would evolve over several years.  In the case of this law, I think that the legislative tussle will also go on for several years, with each side trying to slip in later what it did not get in this first round, and parts even being negated or repealed.


So, with all those caveats & explanations, let me share my thumbnail sketch of how I think our self-funded employee benefit market will be impacted.  (At some later date, I’ll tell you how the attendees of the 2009 SPBA Spring Meeting, and some phenomenal work by several SPBA members steered history and make this a fairly upbeat report.)

Employee benefit plans in general and self-funding were never a target (except, of course, for the hard-core single-payer advocates).  So, I think that we will be relatively unscathed (meaning less than could have been, and than many feared).   I think most problems will be TPAs & self-funded hit as unintended bystander victims of the punitive measures being thrown at insurance companies.  There is nothing designed to subvert your client plans or lure people away.

I THINK THERE WILL BE SOME GOOD THINGS for your client plans.  For example, I think:

>>More young & healthy individuals who, today, who opt out of employer plans because they feel they don’t need health coverage will be in the plan because of the direct or indirect  pressure to be insured.  Some plans suffer badly today from young healthy eligible individuals who decline coverage.  Employers will take a more energetic role in being sure their workers are in the plan, because one probable provision would wallop employers with a fine for $750 per-employee fine if even one ends up getting a government subsidy instead of an employer plan.

>>It will be harder for employers to “go bare” and not have a health plan, so that stabilizes and expands your market.

>>The medical cost “discount” headache looks like it will have a path to ending.  If there is an insurance exchange, public option or whatever in which the government (federal Office of Personnel Management – OPM –  is in the bill) negotiates with doctors & hospitals for a price formula, then I think TPAs and others will adopt that as the de facto Usual & Customary.  This is different than basing on the Medicare price, because back-room deals in 1965 recognized Medicare & Medicaid as a special situation helping the old & needy.   The new public exchanges would negotiate a presumably-fair price for regular people, so it would be hard for doctors & hospitals to say that a negotiated price for regular people is not fair for your plan participants.  The government won’t automatically extend their price to you, but, at last, a credible price list, the same as insurers’, would be available.

>>If the “Cadillac” plan tax remains, cost-efficiency in design & operation of plans will be a gigantic plus.  This has always been a forte of TPAs.

>>There will be changes in the health insurance companies.  Some markets (such as individual policies) might well become money-losers and be dropped.  Insurers may well decide that they want a less-direct role, be it more Stop-Loss or new arrangements with TPAs or whatever.  Meanwhile some non-profit Blues and others will get advantages over for-profit insurers.

>>Some SPBA members have told me that they are already spreading the word among current and prospective clients that no matter what happens and how long it takes to unfold, their TPA (as part of a nationwide network of SPBA members sharing insights & experience) will be on the cutting edge of both the visible and invisible developments.  With insurers and others facing turmoil within their arena, he says that clients and prospective clients are reacting very positively.

SPBA’s ROLE & GOAL will be to work with you day by day to maximize your options as all this evolves.  Unfortunately, in a few days, some SPBA TPA firms will be past-due on their dues & membership renewal forms, and cut off from the services they need.  It is a shame.  TPAs who pride themselves on processing claims in a few days have failed to process SPBA’s simple form in the past 45 days.  Some say “it never arrived”, but it was sent first class mail and not returned.  So, if you think it never arrived, do a thorough investigation of your mail room for what else has been lost.  For some of the excellent individuals who will be dropped in a week, we will miss you, and we strongly encourage you to arrange to get compliance and industry trend services from somewhere.  Sadly, most firms that go it alone lose clients and fade away or end up in deep legal & financial trouble that reflects badly on the whole industry,

For the members who have paid & renewed on time.  Thank you, and stay-tuned.  This will be an exciting time with both frustrations and the biggest opportunities in decades.

Happy New Year.


New “Real”Health Plan for The Young & Healthy – Only $62.50 / Month


Coming soon – a new health plan designed for the young and healthy, generally for those age 35 and younger. Pay only $62.50 per month, or $750 per year to the United States Government – should you subsequently become ill, or need major surgery, you will automatically have the right to apply and be accepted for real health insurance that will cover all pre-existing conditions immediately. After recovering  from your illness and/or surgery, you may drop your real health insurance policy and continue to pay only $62.50 per month until you need real health insurance again!  Pay for real health insurance only when you need it! What a novel idea! Why didnt we think of this before?

Editor’s Note: The communists in Washington know exactly what they are doing with health care reform. They are just about as dumb as a fox – health care reform as now envisioned is doomed to failure and they know it – nothing in the bill addresses health care costs, nothing at all. In fact, components of the health care bill are intended to drive costs up to new highs, and fast. We expect group health insurance costs to increase dramatically in 2010. With the resultant “failure” of private insurers to reign in health care costs, the communists will use that failure as an excuse to create a single payer system. The communists have set the stage for failure – a clever strategy it seems.

We would not be surprised at all if some major health insurance companies exit the business in favor of more lucrative and less government controlled insurance markets.

See Dick Morris article here –

Obesity Center – Matamoros, Mexico


Dr. Rene Perea, FACS, Fellow American College of Surgeons – General and gastrointestinal surgeon advertises services and prices here – His office is 15 minutes from our office in Brownsville, Texas.

Editor’s Note: The prices shown on the website are probably negotiable. For example, we know of a patient from Houston who flew down to Brownsville to seek a gastric by-pass in Matamoros. He negotiated a turn-key price of $3,500. We helped get a price for a San Antonio client recently for $4,500 all inclusive. Potential candidates for these surgical procedures may be wise to offer similar cash offers to US based physicians first. It may be difficult for a surgeon / surgical center to turn down a cash offer of $5,000 here in the United States.

Blue Cross, Hospitals at Odds Over Contract


The most interesting paragraph in this article – – is the following:

“The health system would be happy to consider little or no increase if the resulting savings went to patients and their employers rather than Blue Cross, Finan said. Blue Cross had indicated it will increase premiums by 9 percent to 10 percent in 2010.”

Is this a clue that some carriers do not pass on 100% of the discounts to the consumer, but instead retain a portion of the discount as an additional revenue source? We think this is a very strong clue, coming from a hospital administrator.

SEC Charges Texas Insurance Agent in Million Dollar Scam

By Matt Ackermann

December 23, 2009

The Securities and Exchange Commission filed securities fraud charges against an Austin, Texas investment advisor and two of his businesses alleging he conducted a “multi-million dollar scam” that used former professional football players to promote its offerings.  

The SEC alleged in a filing Tuesday that Kurt B. Barton and Triton Financial LLC, raised more than $8.4 million from approximately 90 investors by selling “investor units” in an affiliate, Triton Insurance, and telling investors that their money would be used to purchase an insurance company.  

The SEC alleged that Barton, who is chief executive officer of Triton, instead used the funds to pay day-to-day expenses at Triton Financial and its affiliate. Triton co-sponsors the Heisman Trophy Trust, an organization that annually honors the best player in college football.

According to the complaint, which was filed in federal court in Austin, Triton used former football players as well as stockbrokers and other salesmen to promote securities and recruit potential investors.  The investment advisory firm, which according to its Web site invests in real estate and manages the securities portfolios of athletes and other clients, has raised more than $50 million for at least 40 ventures since 2004, according to the complaint.

Toby Galloway, a regional trial counsel in the SEC’s Fort Worth regional office, said that the former players aren’t facing any charges right now, but the SEC continues to “look at everyone involved.”

“There is no doubt that having these gridiron greats out there selling these investments certainly played a role in Barton stiff arming money from investors,” he said.

Former Heisman Trophy winners Ty Detmer and Chris Weinke work for Triton along with Jeff Blake, a former NFL quarterback Blake who directs Triton’s “athlete services” department, which is a marketing arm for Triton that recruits players as clients.

“By associating with former football stars, they were able to build a facade of legitimacy and gain investor trust,” said Rose Romero, the director of the SEC’s Fort Worth regional office.

Barton and Triton, which has been registered with the Texas State Securities Board as an investment advisory firm since June 2006, have consented to court orders freezing their assets.  

According to an emailed statement from Barton’s attorney, Joe Turner, Barton “has voluntarily consented to the appointment of a receiver. He intends to work closely with the receiver in an effort to ensure that the investors, many of whom are friends and relatives, do not lose their money.”

In March, Sports Illustrated published an article that described how Triton used former football players to promote its business. Following the article, the Texas State Securities Board conducted an examination of the company. According to the SEC’s complaint, Barton and Triton provided the Texas State Securities Board “with altered and fabricated documents during the examination that followed the article’s publication.

The SEC charged Barton and Triton with securities fraud and seeks permanent injunctions, disgorgement of illegal gains and financial penalties.  The regulator also wants an asset freeze and a receiver over defendants’ assets and operations.

Hussein Blasts Insurance Companies – Insurance Companies Blamed for Crisis in Health Care


Commander in Chief B. Hussein Obama continues to exhort his base with weekly emails. Below is an exerpt of his most recent email to the masses:

“As with any legislation, compromise is part of the process. But I’m pleased that recently added provisions have made this landmark bill even stronger. Between the time when the bill passes and the time when the insurance exchanges get up and running, insurance companies that try to jack up their rates do so at their own peril. Those who hike their prices may be barred from selling plans on the exchanges.”

“And while insurance companies will be prevented from denying coverage on the basis of pre-existing conditions once the exchanges are open, in the meantime there will be a high-risk pool where people with pre-existing conditions can purchase affordable coverage.”

“A recent amendment has made these protections even stronger. Insurance companies will now be prohibited from denying coverage to children immediately after this bill passes. There’s also explicit language in this bill that will protect a patient’s choice of doctor. And small businesses will get additional assistance as well.”

“These protections are in addition to the ones we’ve been talking about for some time. No longer will insurance companies be able to drop your coverage if you become sick and no longer will you have to pay unlimited amounts out of your own pocket for treatments that you need.”

Editor’s Note: Hussein knows that with the passing of the Health Care Reform Bill, insurance rates will necessarily rise. And rise sharply. A Wellpoint study confirms this, with group health rates going up as high as 100% to cover new mandates such as pre-existing conditions prohibition, tier rating basis, community rating, etc. He is preparing his base for the next battle – eviserate health insurance companies so that all will exit the market and a national single payer plan will be required. With only four major health insurance companies left in the national marketplace, it is not unreasonable to believe that they will change their business model from health care to property & casualty cover.

If health insurance companies are so bad, making obscene profits at the expense of the sick, why are there only 4 major players left in the market? And, is a 3-5% profit margin obscene? There are several thousand insurance companies in the United States, and 99% of them dont mess with health insurance. There must be a reason why.

ObamaCare Bill Addresses Gun Control


The 2,000 page plus monstronsity of a Bill has probably not be read by too many people, especially those idiots in Congress who voted for it. Under “Wellness and Prevention Programs” section, gun control is addressed. The Secretary of Health “may not” (as opposed to “is prohibited”) from collecting data on who owns a gun, etc. So, what other “data” is big government to be empowered to collect about us, common citizens?  This is Orwellian – HealthCare Bill – Firearms

If you think this is “fishy”, it is your responsibility to report this to the White House at . Also, if you overhear any of your neighbors speak critically of the Democrat Party, please call Harry Reid or Nancy Pelosi immediately. You will be rewarded.  


COBRA Subsidy Extension Announced


Yesterday, President Obama signed into law H.R. 3324, the Defense Appropriations Act that included a provision to extend federal COBRA premium subsidies.  Currently, it applied to those that involuntarily lost their coverage and were eligible for COBRA to 12/31/09.  The extension makes that timeframe 02/28/10.  It also extend the time period for which a subsidy can be given from 9 months to 15 months. In addition, the legislation would give beneficiaries whose subsidy expired and who didn’t pay the full premium the opportunity to receive retroactive coverage. For example, a beneficiary whose nine months of subsidized coverage ran out November 30 and who didn’t pay the unsubsidized premium for December could pay his or her 35 percent share in January and receive COBRA coverage for December.  The legislation makes clear that employers can offset future COBRA premiums or issue refund checks for beneficiaries who overpaid their COBRA premium. That could happen if a beneficiary whose subsidy ran out in November paid the full premium rather than the 35 percent share in December.

 There are additional notification requirements for those who formerly, currently, or prospectively elect COBRA continuation.  The Department of Labor has not published a model notice yet. 

COBRA subsidy expansion from HR 3324

Jeff Seiler Offers Insight to the Harry Reid Health Care Plan

Jeff Seiler, an insurance consultant from Illinois, sent the following email this morning:
See below from NAHU which is important:
Here is my little summary:
I was also able to scan through about 100 pages of the Manager’s Amendment- otherwise known as Harry Reid‘s personal gift giving for votes. I’m sure no one really read the Manager’s Amendment of 383 pages , which are convenient changes to the real bill (over 2000 pages), but much of it is citing only certain paragraph changes. (Making it incomprehensible to anyone wanting to know what either the real bill or Manager’s Amendment says in total.) Then I got sick to my stomach (i have a strong stomach, so it took a while). Aside from give-aways to Nebraska, etc…here are some things I found to scare the crap out of you:
*Definitions of what will and will not be covered medical expenses….setting the stage for government definition of a full health plan and deciding ultimately all of your benefits.
*Defines that insurance must cover clinical trial participation in phases I toIV (basically forcing coverage of unproven and very expensive treatments that may not work). That alone will drive up costs substantially.
*Calls for investigation of self-funded plans and why they are more efficient, but basically setting up the premise that these plans provide inadequate coverage and are usually less expensive due to claim denials. Believe it or not, there is actual wording in there to that effect, so you know where that is going….bye bye self-funding.
*Provides that plans must notify participants of the appeals process in- believe it or not- culturally and linguistically appropriate methods….can anyone imagine how many languages we now must accomodate?
*Sets up Multi-State exchanges using non-profit companies (not many of those, so you know who wins here), but the plans offered must be available in all 50 states by the 4th year of their existence.
*Penalizes by $600 per employee any large employer who has a waiting period for coverage longer than 60 days-thereby forcing empoyers in high turnover industries to cover employees and incur liability for people who may never really contribute to the bottom line (after hiring and training costs).
*Sets penalites for not getting coverage (unConstitutional) and then sets them so low that people will not buy coverage until they need it and will drop off once they don’t need it—thus driving up costs even further.
*Cites the disaster of the Massachusetts plan as being successful (when it is clearly not) as reason to incur this disasterous plan.
The Manager’s Amendment is also filled with lies about the cost of coverage and what the bill will accomplish as justification for the measures. Harry Reid looks like he is just as good at being a liar as the guy in the White House. Talk on Capital Hill is that the Senate bill will be the one that they pass…they won’t even look at the House bill, since it took so many favors to get the Senate one through, that any changes would stop final passage. therefore, they expect the House to eat crow and vote for this. It’s time to double up pressure on the House.
Editor’s Note: Jeff Seiler’s website is;

Medical Loss Ratio Restrictions Will Kill Insurance

IHC Group
Say ‘No’ to Medical Loss Ratio Restrictions in Health Bill

An early-morning vote Monday means the Senate health care bill could face a final vote as early as December 24th. Certain portions of the bill are problematic for our industry, in particular, the manager’s amendment that would increase mandatory medical loss ratios (MLRs) to 85 percent for large groups and 80 percent for individuals and small group.
We encourage you to contact your senators today. Please read this message from the National Association of Health Underwriters, and contact your senators using letter that appears along with it. Simply fill out your information and click send. 
While we know this is a busy week for many, we must respond quickly. Sending this letter will only take a moment and will make an important impact on your future. Please take action before December 24th.
Thank you for your continued support and for vocalizing your concern regarding issues that affect our industry.

Jeff Smedsrud
The IHC Group fully insured operations

85% Of Term Life Insurance Policies Never Result in a Death Claim



Life insurance represents a valuable fi nancial solution to the various needs of businesses and families. Over time, however, these needs change. Loans are repaid; key executives retire; estates become smaller; businesses are sold; estate taxes are reduced — or better yet, no longer exist. Or, with interest rates down, a policy may just be too expensive.

According to a leading actuarial consulting firm, 88% of all universal life and 85% of all term policies never result in a death claim. In the past, these policies were surrendered to the insurer for their cash value, or worse, allowed to lapse for nothing at all. Life settlements present a compelling alternative. By allowing policyowners to access the market value of their policies, life settlements generate significantly more than surrender value for unneeded policies. And this value can create enormous opportunities for policyowners and advisors alike.

A life settlement can be arranged on any type of life insurance policy, including term life. Face amounts as low as $100,000 are candidates, with life expectancy of 21 years or less. If you have a policy that you no longer need, or know of someone who is about to let their life insurance policy lapse, contact for information on how to convert that life insurance policy into cash.


Fleeced by a Vendor, Hospital System Starts their Own PBM


Does spread pricing get you down? Are you really getting 100% of the rebates? Maybe you should consider starting your own PBM – Fairview Health Systems did just that. They formed their own PBM –  ClearScript is a business of Fairview Pharmacy Services LLC, which is a wholly-owned subsidiary of  Fairview Health Services.  In their first year they saved millions of dollars for the 18,000 employees of Fairview Health Systems –

Health Care Reform – Opportunities for Health Care Intermediaries?

No one really knows what the final Bill will entail. What we do know is that the goverment will cram more mandates down our collective throats. Pre-existing conditions limitations will be a thing of the past, benefit mandates will be tightened, employer contributions will be subject to federal guidlines, punishment (taxes) will be cloaked in various ways – all of this we suspect will be part of the new age of health care in this country.
The question is, will group health insurance sponsors (employers) maintain some degree of autonomy? Will they be able to direct care? Will employers be able to place certain “mandates” of their own? If so, that is where the focus should be for the health care intermediaries in this country who wish to survive (and thrive).
 Editor’s Note: An entire new cottage industry will arise in the health care delivery system. Those that can identify opportunities and bold enought to act will  survive. The rest will become school teachers.

Talk Show Host Responds


We wrote a local talk show host, offering  our views on our current health care system. Below is his response:

Free Markets do not produce solutions they only produce profits. The Free Market of Doctors, Health Insurers etc have created a “class system” in America with regards to healthcare. Over 50 under 65, laid off, got health problems…..tough Born with a disease or disability, tough. Injured from breathing bad air, water or unsafe working conditions. Tough. The wonderful COB RA plan costs more for a family of four a month than 40% of the unemployment paid in states in the USA . Healthcare is a “mafia” who controls the costs, controls the access and controls the lives of all of us. These peoples “death panel” meets everyday, when they do not get cancer screenings and life saving drugs etc….

 I am not a fan of Obamacare, but the free market is a myth. Healthcare costs have gone up 120% in the last nine years. Can you explain that? I appreciate your comments, but what program has the free market offered to fix the current healthcare mess in this country?

 Colonel Ray       
710 KURV News Talk Radio
Listen Online:
On Air Call-In  

Editor’s Note: This was our response: 

Your comments are interesting to me and indicative of the entitlement philosophy of many these days. Health care is not an entitlement nor is car repair. What is driving health care costs is consumer ignorance, greed on the part of the medical care profession, insurance companies who dont care about how much we pay for care, they simply pass on costs to the consumer in the form of higher premiums, taking their cut along the way. Government mandates (benefit mandates) have slowly strangled health care costs – 30% of your insurance premiums go to cover mandates such as breast reconstruction, etc.
Government needs to get the hell out of the way. Consumers need to take control – I have done so with some Harlingen doctors for my own care, and pay less for care than most as a result.
Regarding your last comment, the free market cant function with their hands tied behind their backs. But we try our best with what we have and to date we have been fairly successfull in keeping costs down for our clients. We have one client in the Valley who has kept their health care costs static since 1997 – using innovative risk management to keep benefits comprehensive yet affordable. Money drives behaviour.
Thanks for your response. But you are washed up Im afraid.

Huh? Whatsup with dat?


What good is an insurance offer (proposal) upon which you made the decision to purchase, if you cannot compare it to the governing contract to be placed in force? 


A. Worthless – contract supercedes proposal

B. Binding – proposal supercedes contract

C. Dunno

Editor’s Note: Unfortunately, this phenomenon is becoming more prevalent with political subdivisions who bid out their self-funded employee welfare plans. Proposals are received through contractors (example – third party administrator)  who in turn sub-contracts out various components of the plan (example – pharmacy benefit manager). The proposals submitted by the contractor on behalf of the sub-contractor are not binding upon the political subdivision. Once the proposal is approved, the contract is executed between the contractor and the sub-contractor. The political subdivision thus becomes a third party beneficiary only, and not a party to the contract. Therefore, the contract can be deemed “proprietary” to the contractor and the sub-contractor and the political subdivison will not have the ability to compare the actual contract to the proposal upon which they made the decison to purchase. And, it has been our experience that when you cannot review a contract, that means you are usually paying more than you should.

10th Amendment – States Rights – Will States Resist Obamacare?


Gov. Rick Perry, raising the specter of a showdown with the Obama administration, has suggested in numerous interviews that he would consider invoking states’ rights protections under the 10th Amendment to resist the president’s healthcare plan, which he  has said would be “disastrous” for Texas.

Perry has said his first hope is that Congress will defeat the plan.  But should it pass, Perry has predicted that Texas and a “number” of states might resist the federal health mandate.

“I think you’ll hear states and governors standing up and saying ‘no’ to this type of encroachment on the states with their healthcare,” Perry said. “So my hope is that we never have to have that stand-up. But I’m certainly willing and ready for the fight if this administration continues to try to force their very expansive government philosophy down our collective throats.”


Editor’s Note: The mainstream media is not reporting efforts underway by several states to explore alternatives to Obamacare.

Public Option Could Calm Pricing – A Silver Lining?


“Whether health reform passes or not, there will be some lasting effects that will help. Health Reform has raised awareness that all Americans are not equal in what they get charged for medical services, and sometimes the range of difference is shocking. The recent system of phony discounts that had the effect of propping up inflated health charges is starting to crumble. ”

“If there is a Public Option, especially which would have a negotiated payment rate for providers, any Public Option rate will quickly be adopted by the private sector as the new Usual & Customary standard payment schedule for everyone. Unlike Medicare, which was always seen as a discounted program, a negotiated Public Option rate would have the credibility of the federal government standard of a fair acceptable rate for regular people. Would providers object and try to balance bill? Perhaps at first, but telling a patient that the amount negotiated in good faith between providers and the government is a bogus rate is awkward. This will not happen overnight, but the public and the politicians are recognizing that there is some pricing funny business going on.”

– Fred Hunt, President, Society of Professional Benefit Administrators

Editor’s Note: Preferred Provider Networks will become extinct. Discounts based on inflated and obnoxiously high billed charges are a joke. The Disco Discount Generation, like America’s Greatest Generation, will pass into history as a brief footnote.

TRS ActiveCare Financials

For fiscal year ending August 31, 2009, claims to contributions (loss ratio) is approximately 95%. Taking into account cost of administration, the net results for the fund is (-) $69,036,559. With established reserves, the net balance of the fund is estimated to be $ 486,766,302. 

Claim costs pmpy has increased from $3,361 to $3,527 over the prior year, representing a +4.5%.

We expect a modest rate increase to the fund. This should be announced in March 2010 by the TRS ActiveCare Board of Directors.

Code Red Report – The Critical Condition of Health Care in Texas


The report of the Task Force on Access to Health Care in Texas: Challenges of the Uninsured and Underinsured was issued April 17, 2006. The Task Force represented a nonpartisan group sponsored by all 10 of the major academic health institutions in Texas, as well as representatives from large and small employers, hospitals, health policy experts and community and business leaders. This Task Force was comprised of some really smart people, much smarter than most of us earthlings.

The Task Force collected data, identified and assessed the magnitute of the problem of the uninsured in Texas, and made recommendations for consideration by policymakers (career politicians).

Here are their findings: A lot of folks in Texas are unhealthy and uninsured.  Health insurance is costly.

Their recommendations: Garner more federal monies (tax), implement a 3% punishment fee  (tax) to all hospitals and surgical centers, give preference in awarding government contracts to those contractors who show proof of health insurance, adopt punishment (tax) policies that “encourage” employers to provide health insurance for their employees, adopt a “share subsidy” (tax) for small employers, mandate 60 minutes a day for exercise for Texas public school children, expand  (taxes) the School Breakfast Program, increase “investment” (tax) in the education and training of health professionals, adequately invest (more taxes) in public health programs, among numerous other recommendations along the same lines, i.e, “Throw Money At The Problem And Everything Will Be Just Fine.” Taxes solves problems” seems to be the universal answer these days.

We read this Code Red Report three times. Surely we were missing something we thought. Unable to reconcile this report with our inner sense of values instilled in us by members of America’s Greatest Generation (our parents), we appointed Molly Mulebriar to head our own Task Force to study the issues addressed in the Code Red Report. Here are our findings:

Our Findings: A lot of folks in Texas are unhealthy and uninsured. Health insurance is costly.

Our Recommendations: No need to inform Texans that many of them are unhealthy and uninsured and health insurance is costly – they already have figured that out on their own. No need to  recommend that they do someting about it on their own – they are generally smart enough to have figured that out too. For example, they know that when they visit the grocery store, they should buy “good stuff” instead of the “bad stuff.”  And they know that If you really want health insurance, you can buy it, guaranteed in Texas, if you are willing to give up your cell phone, Saturday nights out on the town, and those expensive vacations to Tahiti.

If the goverment wants everyone to have health insurance, why dont they mandate that for everyone who shows proof of health insurance, the government will pay for their cell phone, Saturday nights out on the town, and at least one annual vacation to Tahiti – after all, we are all entitled to that arn’t we?

A free and unfettered market solves problems – government intervention generally exaserbates them

Molly Mulebriar summed up the problem by saying “If costs are high, offer to pay less and find someone who will accept it. This is called  a ‘Free Market Economy’ which has worked so well for the past 200+ years in this country.”  


Molly Mulebriar – American Hero

Code Red Report here:  code_red_synopsis

Blue Cross Could Be Big Winner in Senate Bill


A compromised announced this morning by members of the United States Senate regarding a “government option” as part of the health care reform bill, stipulates that any insurer can offer a plan through exchanges, however “the plan itself would have to be non-profit.” That leaves two  key players; Kaiser and Blue Cross.  For profit carriers like Aetna and United HealthCare would not be allowed to compete for business through the exchanges.

Editor’s Note: We expect easy passage of this bill – pundits report there are 60 votes “in the bag”.  A vote may take place as soon as next week.

4% “Hidden Fee” Basis of Lawsuit


A lawsuit filed in October 2007 by Oakland County against Blue Cross & Blue Shield of Michigan may have a wide ranging impact on PPO contracts. In 2006 Blue Cross presented their client with a new administrative contract on renewal. What caught the attention of Oakland County officials was the following language:

“A portion of your hospital savings has been retained by BCBSM to cover costs associated with the establishment, management and maintenence of BCBSM’s participating hospital, physician and other health care provider networks. The ASC Access Fee also covers any subsidies, surcharges and contributions to reserves order by the State Insurance Commissioner as authorized pursuant to P.A. 350.”

This was new language in the contract and was not in previous contracts in prior years. According to the lawsuit, “Since this proposed contract provision was significantly different than prior proposals, Plaintiff requested from Defendent an explanation regarding the new language and especially the ASC Access Fee. Among other things, Defendent responded, in essence, that the ASC Access Fee had been charged to Plaintiff for many years, but was not disclosed. Defendent stated that it “retains a portion of the provider reimbursement savings that it achieves for it’s group.” In other words, when Defendent received a discount on a bill from a hospital, it did not pass the entire discount on to Plaintiff.”

Oakland County estimates that this alleged “hidden fee” amounted to about 4% . In researching their claims since the initial inception of the BCBS health plan for their employees, Oakland County projects that the 4% fee amounts of over $10,000,000, a sum for which they are now seeking reimbursement.

Editor’s Note: In reviewing a BCBS hospital contract, we noticed the ASC terminology within the contract. Yet, how many of our readers have ever seen a BCBS hospital contract? We would guess none. (It took us 7 months to track one down – an effort well worth the time). For a copy of the original pleading, email . The outcome of this lawsuit may have wide ranging implications for all PPO networks.

Attorney General Rules Against the Brownsville Independent School District


Public requests for information surrounding the recent BISD award of a $40 million insurance contract have been met with resistance by the district. They have appealed to the Texas Attorney General to deny release of information.

A recent letter from the Attorney General to the BISD dated December 2, 2009 is encouraging.  The BISD was advised that they must release certain information that has been requested. This is good news for the taxpayers of Brownsville.

It is all about accountability and transparency. The public has a right to know how their taxes are spent. Public officials need to be held accountable. When asked to review the accuracy of a $371,000 apparent descrepancy, one would expect a straight forward and expeditious response. After three months, a cogent response remains elusive.

Editor’s Note: It has been our position that when a third party beneficiary of a contract is not allowed to see that contract, it usually means they are paying more than they should.

Donna ISD Board Member Pleads Guilty


Editor’s Note: This is just one more guilty plea of a public official in the Lower Rio Grande Valley where corruption runs rampant and unchecked. It is no wonder that many insurance companies have Red Lined the Valley. Unfortunately, those that do compete for business and are successful, are viewed by many to be corrupt as well. After all, is there not any other way to obtain lucrative insurance contracts in the Valley other than through mordida?