You probably don’t know what the title of this blog entry means.

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Living in the Lower Rio Grande Valley in deep South Texas has its advantages. Going across the river to get cheap drugs is a time honored tradition.

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Aldeen’s Famous Sunday Bathroom Read – A Continuing Series on Linkedin

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How does 125% of Medicare compare to 200% of Medicare in relation to average PPO allowed rates and how does 80% of billed charges compare to all of the above? How will the Independent Dispute Resolution process under the No Surprises Act determine out-of-network reimbursement?

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CIGNA paid Florida surgical center $75,000 for an operation done at their facility. But the surgical center wants $434,000.00 more…………….

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With transparent pricing, contracted rates are out of the shadows………and ASC’s are a lot cheaper than hospitals.

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Psst……..Wanna know how I find markets?

Website for agents to find insurance markets of all kinds for their clients…..

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Burns was a financial savant who, while still in his early 20s, gained control of several insurers and a brokerage firm through a company called Southport Lane Management.

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WHEN COSTS DO NORMALIZE, THERE’S NO CHANCE THEY’LL RETURN TO EARLIER LEVELS……………..

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Self-insured retention (SIR) programs allow insureds to retain more control of their assets.

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Do something about the high cost of health care or else! says Indiana. Otherwise legislative leaders say they may have “no choice but to pursue legislation to statutorily reduce prices.”

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A Reference Based Pricing plan having direct provider agreements is a network plan as defined by the government………………..

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Blue Cross has launched a new 2022 Retail Bonus Program with a tiered schedule based on production. Insurance agents can earn an extra $30,000 in just 30 days…………..

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While UnitedHealth reports $24 Billion in profits, Americans faced 200% increases in out-of-pockets over last decade

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Why can’t we seem to solve health care? Because the majority is always wrong…………..

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Base Plan

• ACA Mandated Preventive Care
• Unlimited PCP Virtual Visits
• Unlimited Urgent Care Virtual Visits
• Over 250 Free Generic Drugs
• $1,000 Per Year Radiology & Lab
• Hospital FAP Concierge Service

Employer Cost: $ 100 pepm

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The Assembly Appropriations Committee passed Assembly Bill 1400 on Thursday, which would create a government-funded health care system in California known as “CalCare.” The proposal would expand medical coverage to all California residents under a single-payer structure………………..

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A student accident insurance company underwriter once confided to me how he rates his renewals. “It’s easy peasy” he said.

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Regional service centers have now been effectively placed in a position where they must make a recommendation to the state as to whether a commercial health plan alternative is better for member districts than the TRS ActiveCare government plan.

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California Hospital Administrator Reacts

The bill would eliminate commercial health insurance and Medicaid coverage in California and replace those forms of coverage with CalCare, a government-run health plan that will pay medical care givers 100% of Medicare allowed charges………………..

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Henry  “Hank” Miltenberger

“When you go public, it changes the culture. That can be good for some companies, but we’re glad we don’t have to worry about quarterly earnings reports. I’ve never considered selling Gilsbar. I don’t view the business as a investment. It’s a stewardship. I hope to hand it off to someone with the same values—values where people are a priority over dollars.” (Up With People – New Orleans Living Magazine)

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I saw this photo on Linkedin this morning and it reminded me of Albert, a South Texas native with one of the biggest set of brass cojones ever recorded within the insurance industry…………..

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Heath care in this country has essentially become a government regulated utility. New 2022 health care mandates are causing employers more headaches and putting them at additional risk for punishing sanctions if they fail to comply. And if you have a network plan, more regulations may be coming in 2023.

It may be time to drop your network………………..

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 In instances in which the overrides are shared with brokers and consultants, even if only in the form of rewards, trips, prizes, or gifts, etc., disclosure is required based on what appears to us to be a plain reading of the rule.

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Plan Sponsor Gives Up – Moves Factory To China

“In a world where payers will be forced to pay more, and providers are not punished for charging excessive amounts, there is no downside to charging more, ignoring negotiations, and waiting for arbitration.” – Ron Peck

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Government Bureaucrat Memorializes Regs

The interim final rule published in July 2021 clarified that the NSA is applicable to indemnity plans, which suggests that reference-based pricing plans would also be covered by the law.

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“I never had a call that an employee had been billed for the difference for an out-of-network provider or got stuck with a big surprise bill. And that is so important because that is a fear” – EPO Plan Sponsor

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Sometimes we lose an understanding that history and the human experience is eternal. This video gives insight tied to both. Things that are said to never change do……………

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    2022 TRS ActiveCare Theme Song by Queen

“When we started looking at this … we thought this was going to be a tough decision,” Zeller said after the meeting concluded. “But when we started researching, the quality of the products out there, the caps the companies were willing to give us, a three-year cap on increases, it made it evident the market helped us make this decision.”

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Out of the blue a dark horse out-of-state TPA captures Texas school business from right under the noses of Texas based TPA’s vying for the same business……….Region 14 Education Service Center, Abilene Independent School District, Crowley Independent School District, and Pearland Independent School District…………….

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Two guys in Colorado started Friday Health Plans six years ago and have now expanded into Texas…………………

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The telehealth bubble has burst. Time to figure out what’s next

Telehealth took off during the pandemic, but 2021 was a brutal awakening. The healthcare industry is still figuring out how it fits into the big picture.

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Plan Sponsor Reacts To Sales Pitch

A 500 life case is in the process of renewing their group health insurance plan. Their claims are running hot.

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