Archive for August 18th, 2014

The Effects of ACA On Price Transparency

Monday, August 18th, 2014

With the passage of the Affordable Care Act, transparency in medical pricing has gained added traction. Narrow networks, i.e, less expensive providers, is one trend, while the other is reference based pricing which is necessarily based on transparency. Health insurance has now become more of an individual responsibility and less of an employer’s moral responsibility. Consumers are beginning to recognize this. Once consumers have skin in the game, cost transparency becomes a market demand upon which medical care givers either do well or lose business.” – William Rusteberg

Recommended Reading

The Business Of Medical Practice: Transformational Health 2.0 Skills For Doctors by David E. Marcinko & Hope Hetico.

Page 33:  “Similarly, is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and faiirness in direct reimbursment compensation methods – William Rusteberg, 2010, Personal Communication – ”


Allied National “Provider Freedom” Plan – Sales Surge In Texas

Monday, August 18th, 2014


Allied National is seizing advantages in Texas with their self-funded “Provider Freedom” plans. Provider Freedom plan sales represent 85% of new business sales for this Kansas based third party administrator. According to sources at Allied National, mid-market cities (Midland – Odessa – Longview) have been stronger markets than the metro-plexes, however traction is beginning to take hold in the larger metropolitan areas as well.

The Provider Freedom Plan is not a PPO program and is very similar to Cost Plus Insurance.

For more information, contact Dan Meylan, National Sales Director of Allied National @

Previous Postings:

Allied National’s Cost Plus Health Insurance Takes Off

A Group Medical Plan Without A PPO & No Balance Billing Issues?

Mystery Guest Touts “Participating Contract”

Monday, August 18th, 2014

secret I’ve Got A Secret

We have been looking for a stop loss carrier that offers an old fashion participating contract for many months now. Well, we found one. Mystery Re has an experience refund calculation on their stop loss policies. Much like a participating contract without the downsides. Minimum premium is $500k. This carrier also has a “laser pool” for their groups. 

A participating contract is better than using a captive – no management fees, no capitalization, etc.

Editor’s Note: Mystery Re is a pseudonym. Write for details.