Good news for frustrated Plan Sponsors. They don’t have to screw with group health insurance anymore………………….

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Cash Pay Centric Health Plan Model

A 400 life case implemented a Cash Pay Centric Plan effective January 1, 2021. To date results have been good.

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Man Pays $4,532.09 In Cash At Grocery Store

With all this funny money being printed without anything of value backing it, I suspect we will see a Jimmy Carter economy unfold in full force within the next 18 months.

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The Rush Towards Individual Coverage Gains Momentum 

“The employer mandate penalty trigger is if an eligible employee qualifies for a subsidy through an exchange.  So if more people are suddenly rushing to the exchanges to see if they might be eligible for cheaper coverage, employer liability risk might be going up. ” 

Are Texas school districts for example, many of which don’t pay all the cost of employee health insurance, at risk too?

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TCTA’s Solution To Controlling Costs – Pay More

The Texas Classroom Teachers Association recently posted “Why ActiveCare may be on the verge of a big, big problem” and offered AN IDIOTIC SOLUTION TO CONTROL HEALTH CARE COSTS.

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Significant savings are achieved using a cost plus approach to health care provider reimbursement on hospital charges. Little savings are evident on professional charges.

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File this under “You Got To Be Kidding Me!”

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TRS ActiveCare Requires Intensive Care – Prognosis is Guarded

We are in a different world now than the one we were in twenty years ago.

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Student employs proven risk management strategy against personal injury risk, putting university at risk of financial loss through potential litigation should student’s strategy be triggered.

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Proposed Senate Bill 1444 was amended this afternoon to include provisions that would prevent Texas school district members of the TRS ActiveCare government health plan from offering competitive commercial health care alternatives for their employees.

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USA Managed Care Organization, Inc. (USA MCO) introduces Alter-Net Medical Services, Inc.  Alter-Net offers self-funded employer groups and insurance companies a predictable payment model through Alter-Net’s Reference-Based Pricing Network.

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“It’s not fair!” says Status Quo Sally, “Our competition is stealing our business with lower rates and better benefits. They can afford to because they are not covering specialty drugs!”

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Agents enjoy direct access to numerous carriers such as Encompass, Travelers, Berkshire, Liberty Mutual, Allstate & more……………

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Bill Title: Relating to services provided by freestanding emergency medical care facilities. “A facility that provides acute care services may not charge an emergency facility fee for providing the services.”

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Bill Title: Relating to eligibility to establish a multiple employer welfare arrangement.

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By Bill Rusteberg

TRS ActiveCare is a Texas government health plan for public school districts established over 20 years ago. Participating districts include over 90% of all Texas public schools comprising almost 500,000 members.

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A Senate bill introduced in the Texas legislature yesterday, if passed, will allow Texas school districts, for the first time in 20 years, to exit the TRS ActiveCare government health plan. A companion bill was introduced in the Texas House of Representatives.

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TRS ActiveCare trustees are hopeful the Texas Republican controlled legislature will restore the TRS ActiveCare government health plan monopoly by prohibiting commercial competition.

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Republican controlled Texas Legislature may move to give government health plan an exclusive monopoly prohibiting commercial competition…………………..

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Looks like this has passed the House and is on to the Senate.

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First there was news earlier of this year of Tenet’s attempts at a second bite of the apple .Now word reaches us that another hospital system may be gearing up to do the same.

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After 40 years of relying on managed care strategies to lower health care costs without success, why are we still doing it?

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Source: ACS Benefit Services, 4/16/2021

Winston-Salem, NC – ACS Benefit Services has announced a new partnership with Green Imaging, a national, full-service virtual medical imaging network that is owned and operated by a group of board-certified radiologists.

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In the early 90’s, Bill developed a very successful program for Reference Based Pricing, putting together all the necessary components for success, and championed this approach in all the years since then, along with assisting self-funded employers in effectively utilizing proprietary clinic settings for benefits. 

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TRS ActiveCare is effectively, without any desire to do so, on the road to becoming a de facto stop loss carrier………….

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“We’re trying to keep pace with health care costs…….”

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Blue Cross of Texas can’t be very happy about this nor can their largest Texas client.

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I wanted to follow up from my previous email and share our resource that provides insight on how to make medication and treatment for acute and chronic conditions more affordable.

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If you are paying more than $10 for a Silver equivalent health insurance plan through your employer, you may qualify for a better deal in the individual health insurance marketplace.

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“Next year these districts will have access to their own claim data with which they can directly competitively bid out their TRS ActiveCare alternative plans. That will be a game changer.”

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90 Degrees Benefits Blitzkrieg

By Bill Rusteberg

For the first time in almost 20 years the TRS ActiveCare government health plan for Texas school districts must compete for business. Previously this government funded public health plan held a monopoly on Texas school business, protected by statute from commercial competition.

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Two legislative sessions ago (Texas legislature meets once every two years) I was involved with a group whose goal was to influence certain legislative initiatives towards reforming public health care financing in Texas. We met with all the right people as well as highly connected lawyers active in the political arena. It quickly became evident we were not going to be successful without hiring them directly or their surrogates on a monthly retainer fee basis.

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Reference Based Pricing Vendor Reacts

Texas Attorney General Opinion issued April 13, 2021 negatively affects Reference Based Pricing plans in Texas.

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Are you getting proper underwriting credit for your Reference Based Pricing plan?

“When it comes to stop loss options, most carriers are pooling the highly engaged employer with a large block of business made up of groups who have not adopted the best programs to contain costs and improve the lives of their members.”

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Cash-pay centric health plans are turning TPA’s into Maytag repairmen lookalikes. In this case the phone has stopped ringing by 90%………………

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The first documented PHI breach by government officials…….Government operatives steal PHI from locked filing cabinet for political purposes……

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Check out the Redistribution of Wealth Calculator to find out if you qualify…………….

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“What did you just say! Free Drugs? Where?

If you’re single earning less than $75,000 you will qualify for free specialty drugs through Big Pharma. Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine.

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Epic Systems founder Judy Faulkner built an empire pioneering—and later dominating—electronic medical records. For decades, she’s kept them walled off from competitors, but now the pandemic is fueling a digital health care race that might finally topple her from the throne.

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Chinese manufactured flu virus spawns instant Chinese billionaires and others across the globe. Manufacturing a problem then selling a solution is very smart business.

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“We eliminate the middlemen,” says Schuessler, inventor of The Schuessler Stick™.

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I thought your readers would benefit from our guide on financial assistance for prescription medication……………..

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Founded in 2013, Continental Benefits operates in all 50 states.  It is a privately owned organization headquartered in Tampa, FL.

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I’ve often argued that health insurance companies in the U.S. provide almost no real insurance because they assume almost no actual risk from the people they cover. I think their financial disclosures from last year back up what I’ve been saying.

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Just because you can charge $2.1 million doesn’t mean you should charge that amount.

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Texas based insurance group receives word via Linkedin. Waiting for confirmation call from Oslo.

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