Archive for January, 2022

Tongue Tied Dog-Face Open Closet Pony Soldier

Monday, January 31st, 2022

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

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Mexico Rx Dispensing Machine – No Prescription Needed

Monday, January 31st, 2022

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 Sunday Bathroom Read

Sunday, January 30th, 2022

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

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How Will Out-of-Network Reimbursement Be Determined Under NSA?

Saturday, January 29th, 2022

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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Surgical Center – “CIGNA Screwed Us!”

Saturday, January 29th, 2022

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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ASC’s To Benefit From Transparent Pricing

Saturday, January 29th, 2022

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

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Website for Insurance Brokers Searching For Markets

Saturday, January 29th, 2022

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

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

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Insurance Mogul Assumes Room Temperature

Friday, January 28th, 2022

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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Health Plan Fiduciaries Must Solicit Information from Brokers and Consultants

Thursday, January 27th, 2022

Bill, can you hide $150,000 in commissions in the TPA admin fees?……………………

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TOP FIVE COVERAGES THAT INFLATION CAN AFFECT

Thursday, January 27th, 2022

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

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Self–Insurance Retention (SIR) Programs

Thursday, January 27th, 2022

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

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Consumer Rage Spurs Government Action To Tame Healthcare Costs

Wednesday, January 26th, 2022

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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Are Some Reference Based Pricing Plans “Network” Plans?

Tuesday, January 25th, 2022

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

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Blue Cross Bonus Program – Earn An Extra $30,000 in 30 Days

Tuesday, January 25th, 2022

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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That Will Buy Off A Whole Lot of Deductibles…………….

Monday, January 24th, 2022

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

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Mr. Sidgewick

Sunday, January 23rd, 2022

By Bill Rusteberg

Mr. Sidgwick“Self insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this an essential health benefit under the ACA?”

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Why The Majority Is Always Wrong

Sunday, January 23rd, 2022

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

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MedSave Management Blue Collar Health Plan

Saturday, January 22nd, 2022

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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California’s Proposed Single Payer Healthcare Clears Another Hurdle

Friday, January 21st, 2022

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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How To Field Rate Any Insurance Risk

Thursday, January 20th, 2022

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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TRS ActiveCare Under Siege

Thursday, January 20th, 2022

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 Poised To Pass Single Payer Reference Based Pricing Plan

Wednesday, January 19th, 2022

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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But Hank Said……………………

Tuesday, January 18th, 2022

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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Albert

Thursday, January 13th, 2022

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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Network Adequacy Standards For QHPs And More Guidance For 2023

Wednesday, January 12th, 2022

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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General Agents & Compensation Disclosure Rules

Wednesday, January 12th, 2022

 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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I Hate Surprises

Monday, January 10th, 2022

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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What Plans & Services Are Impacted by NSA

Monday, January 10th, 2022

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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The Rise of EPO’s

Sunday, January 9th, 2022

“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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The Healthcare Industry & The U.S.S.R.

Saturday, January 8th, 2022

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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CPAs Shift Audit Risk to Plan Fiduciaries

Friday, January 7th, 2022

SAS 136  increases the need for error-free payroll files and impeccable compliance in areas like compensation, distributions, and vendors’ fees.

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Abilene ISD Opts Out of TRS ActiveCare

Wednesday, January 5th, 2022

    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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Dark Horse TPA Acquires Texas School District Business

Tuesday, January 4th, 2022

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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A Health Insurance Company You Never Heard Of

Tuesday, January 4th, 2022

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

Tuesday, January 4th, 2022

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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Group Health Insurance Is Not What It Used To Be

Monday, January 3rd, 2022

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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