“Now you can earn $100 per enrolled employee for every NEW Small Group (5 to 50 employees) you enroll into our Anthem Balanced Funding (ABF) plans, through 6/1/22 effective dates. Thereʼs no cap on how much you can make.”

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“Maine’s Democratic governor, Janet Mills, signed legislation directing the Maine Health Data Organization (MHDO) to report annually on the potential savings if certain drugs were subjected to a referenced rate, which is the lowest of the prices available among Canada’s four largest provinces and the wholesale acquisition cost, beginning January 1, 2023.”  MORE >>

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Watch a health insurance renewal presentation on a 450,000 life case unfold before your very own eyes! Will rates go up? Will benefits reduce? Or will something magical happen?

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“Blue Cross Members Get a Network with 95% of Doctors and 96% of Hospitals in the U.S.”

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“The most effective way to address the No Surprises Act (NSA) legislation, particularly elements of the Independent Dispute Resolution (IDR) process, may be to adopt a pure RBP plan that does not contract with providers……………….”

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Do you shudder when a prospect tells you they are diabetic?

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The open portions of the April 28, 2022, meeting are being broadcast over the Internet…….

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Texas hospital officials expressed relief that the future of the waiver was no longer in question but continued to push for other programs to help pay for the care of Texas’ uninsured population — the largest in the nation.

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By Doug Aldeen on Linkedin

In Alec Baldwin’s iconic role in the seminal 1992 movie, Glengarry Ross, he advised his underlings to “always be closing ” (“ABC”). In Colorado, for hospitals under HB 1285, “ABC” =always be compliant… .

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Government To Remove ACA Handcuff?

The Telehealth Benefit Expansion for Workers Act would allow employers to offer standalone telehealth service programs……………

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A reference based pricing plan having direct provider contracts is by definition a “network” plan. (See definition of “in-network” in Code of Federal Regulations, 147.210, XII) In that instance a plan sponsor must publicly display in-network information containing name, CPT code and negotiated rate and fee schedule rates.

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“Coming soon to a television near you: Our own Doug Aldeen is featured in this upcoming series on medical debt by our news partner KXAN TV in Austin, Tex.” – Jeanne Pinder – Founder, CEO, clearhealthcosts.com

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Car dealer’s approach to health insurance lifts employees and profits

As working Americans struggle to manage the rising cost of health care, one Lakeland car dealership has developed a new way of trying to close the door on higher costs.

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How do you compare financial performance between two group health plans? How do you determine which plan is outperforming the other in terms of dollars only?

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“It’s easy to get Medicaid, for sure,” Dr. Lazzopina says. “But just because you have a card doesn’t mean you’re going to get an appointment, at least any time soon.”

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Is government health plan financing simply a price fixing scheme having little to do with supply and demand resulting in constricted access to care in an otherwise (almost) free market system?

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By Bill Rusteberg

Sometimes we read things and wonder “what the heck were they thinking when they wrote this? Is there something I’m missing here!”

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John Kirke leads BevCap Management’s healthcare captive team, client services and growth strategies empowering clients to create value for their organization through healthcare benefits sponsored in stop loss captives.

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A.J. Loiacono Doesn’t Mince Words

Trying to understand the mystery world of American drug pricing will drive one to the nut house faster than you can spell P-H-A-M-A-C-E-U-T-I-C-A-L-S.

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By Bill Rusteberg

A patient in severe pain barges into the doctor’s office screaming “I need to see the doctor! I’m in pain, terrible pain! Please, tell the doctor I need help!”

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The DPC Coalition and American Academy of Family Physicians spent two years in collaboration with Milliman and the Society of Actuaries on a comprehensive evaluation of Direct Primary Care (DPC) as a growing health care delivery and financing model.

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By Bill Rusteberg

Years ago when I was a sales representative for a health insurance company a disgruntled plan member cornered me, screaming her claim was denied. “Our insurance sucks! I pay a lot of premium and I don’t get anything in return!” she screamed for all to hear.

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Last fall the Texas legislature gifted the TRS ActiveCare health fund +$200,000,000 and called it “Covid Relief.”

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Specialty is a growing specialty insurance Company, delivering commercial property and casualty products and solutions on a non-admitted and admitted basis.

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Santa & His 435 Elves (Congress) Declare Xmas In The Spring!

Other people’s money would help offset the high cost of coverage in employer-sponsored plans……….

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Hub continues acquisition spree

by Ryan Smith 11 Apr 2022

Global broker Hub International Limited has announced that it has acquired the assets of Marketing Management Associates. The terms of the transaction were not disclosed.

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Dream vacation for the uninsured………………………….

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One hospital wants an 88 percent higher reimbursement for its providers in the next four years…………Another hospital wants a 30 percent overall rate increase, including a 50 percent increase for some services…………

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“I successfully defended my dissertation titled: A CASE STUDY OF GROUP HEALTH INSURANCE COVERAGE AT ONE TEXAS SCHOOL DISTRICT, earning an Ed.D. from Lamar University. My dissertation was a single case study of group health insurance coverage at Raymondville ISD. “ – Ben Clinton

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The Department of the Treasury (Treasury) notice of proposed rulemaking on the “family glitch” expands eligibility for free government money to employees’ families when their share of their employer-sponsored premium is deemed to be unaffordable by  faceless bureaucrats in Washington.

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A direct primary care organization (DPC) charges $60 per member per month or $720 per member per year. According to government statistics PCP visits per 100 = 136 or 1.36 visits per person per year.

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Failure to comply with new community health needs assessment rules under the Affordable Care Act resulted in a non-profit hospital losing its tax-exempt status back in 2017. Has there been other cases like this since?

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Failure to meet these requirements can have significant consequences……………….

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Hospital Administrator & Family Attend Movie Premiere

What if you could protect employer health plans and their members from excessive and often incorrect hospital charges? Watch our fast-moving 30-minute video with Doug Aldeen, prominent healthcare and ERISA attorney, and learn how to challenge and change this costly dynamic.

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“Recently we asked a not-for-profit hospital for a copy of their Financial Assistance Policy. Instead they directed us to their website where, they said, we could find all we needed to know about their Financial Assistance Policy. We did, and it didn’t. So we asked the hospital a second time for a complete copy of their Financial Assistance Policy. To date they have not responded. So, it’s been over 30 days now and it’s time to file a complaint with the proper federal authorities to remove their not-for-profit status. They can’t have their cake and eat it too” – Bill Rusteberg

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Leslie Donovan followed the blueprint I laid out in “Never Pay the First Bill” to sue Sutter Health, leading to a refund and cleared balance.

Marshall Allen

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Vendors, We are opening the bid for RFP-0422-SI, Student Insurance. Please go to the link below:

https://sbcisd.edlioschool.com/apps/pages/index.jsp?uREC_ID=900856&type=d&pREC_ID=2305758

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With great sadness we announce the passing of Nola Ortiz. Nola is survived by her three sisters, Ava, Allie and Anna and Boudreaux (Buddy) Wilson III.

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Employers these days are subject to government oversight to an extent never envisioned by our Founding Fathers. Failure to comply with onerous government mandates can lead to crippling punishment at the hands of faceless bureaucrats lurking within the Deep State……………..

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By Scott Fuqua on Linkedin

(Experienced Healthcare Professional with nearly 25 years in the industry. RBR, Medical Bill Review, Cost Containment)

If PBMs could lower the cost, why are they not doing so? Just like the PPO Network middle men, the traditional PBM model is an absolute PROVEN FAILURE.

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Sunday Morning Bathroom Read, Spring Edition, Vol. 1, Article 1

“Now we can confirm why the person hit by the semi was marked as COVID on the death certificate” – Doug Aldeen

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