Archive for July, 2022

Texas School District Explains How They Solved Health Care

Saturday, July 30th, 2022

Dr. Benjamin Clinton explains how the poorest school district in Texas solved health care………..

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Blue Cross Gives Small School District Better Deal than TRS ActiveCare

Saturday, July 23rd, 2022

Blue Cross has given a small school district in deep South Texas a better deal than TRS ActiveCare with over 400,000 members………………. (more…)

When Reason & Logic Won’t Win The Argument, Arm Twisting Will

Saturday, July 23rd, 2022

By Bill Rusteberg

I’ve been dealing with hospital administrators since the 1970’s and during the years since little has changed. I know exactly what the hospital administer will say and do during the negotiation process, their tactics, including the traps they set for amateurs.

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You Don’t Want Me To Know Your Business Because It Won’t Be Good For You!

Friday, July 22nd, 2022

By Bill Rusteberg

Recently I was referred to a large medical group that was interested in learning more about how we help plan sponsors manage their employee health care needs. They were fully-insured with a BUCA and tired of double-digit rate increases year after year.

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Panning for Gold – The Great PCP Gold Rush

Friday, July 22nd, 2022

Amazon is acquiring One Medical for $18 a share, an all-cash deal that values the primary health-care provider at roughly $3.9 billion, the companies said Thursday.

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A Cure For The Royal Disease?

Thursday, July 21st, 2022

New England Journal of Medicine reports a transformational therapy has effectively cured the Royal Disease………..

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Source of All Evil – Woke HR Departments

Thursday, July 21st, 2022

Separating The Sheep From The Goats – Matthew 25:31–46

I have hated this business for a long time but I love being an outlaw helping companies escape the prevailing death spiral…………………………..

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Build Your Own RX Plan – Bypass Predatory Business Models (PBMs)

Wednesday, July 20th, 2022

“Don’t bother doing something unless your radically different from the competition”– Richard Branson

By Bill Rusteberg

Building a Rx benefit plan without a PBM (Predatory Business Model) is beginning to make sense for plan sponsors whose Rx costs are as high as 50% of total plan spend. They no longer view their plan as a health plan but as a Rx plan with health benefits attached.

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My Dog Has Better Health Insurance Than I Do!

Monday, July 18th, 2022

While chasing a squirrel in the woods, beloved pet dog tore the anterior cruciate ligament in her left knee. Turns out she had better insurance than her master………………………………

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And Now…………The Rest of The Story

Monday, July 18th, 2022

If Paul Harvey were alive today and had read the following article, he would have found fertile material for his “The Rest of The Story” radio show…………………………

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Plan Sponsors To Lose Discretionary Authority?

Monday, July 18th, 2022

Plan Sponsor Employs Discretionary Authority

Does your plan contain a discretionary authority provision? The government may be taking that away if HR 7740 passes. It will prohibit arbitration in ERISA claims and discretionary authority clauses.

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PBM Shell Game – Hiding Fees Through Middlemen

Sunday, July 17th, 2022

Are PBM’s Adding Another Middleman To Avoid Transparency?

Are PBM’s creating another intermediary in the supply chain to prepare for transparency requirements? They stand to lose a lot if they get regulated on rebates. By creating another organization that’s offshore, they can protect their interests…………….

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Wife Saves Husband – Stuns Doctors

Saturday, July 16th, 2022

AUSTIN, TX – “He’s turning into a shell of his former self”, his wife cried.

Lee had become so frail that it took every ounce of energy just to hoist himself out of his scooter and into his favorite Lazy Boy.

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Underwriting Health Insurance Plan Made Easy

Saturday, July 16th, 2022

Formulas for establishing health insurance renewal rates:

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US Allows Pharmacists to Prescribe Paxlovid Directly

Friday, July 15th, 2022

Article Referred By Jody Bright

Pharmacists can now prescribe Paxlovid, Pfizer’s COVID-19 antiviral pill, directly to patients.

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U.S. Online Pharmacy Offers Huge Savings

Friday, July 15th, 2022

Prescription drugs don’t have to be as expensive as they are. A smart plan sponsor, thinking out of the box, would discover tremendous savings if they seize advantage of opportunities available in the free market.

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Villains of Health Care

Friday, July 15th, 2022

“Pharmacy Benefit Managers are one of the three most influential opponents of price transparency……………….. If the true cost of a medication were known this would shine a light on the fraud taking place, so the PBMs hide the costs at every turn”

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Only 26 Percent of U.S. Physicians Are Still Independent. Why?

Thursday, July 14th, 2022

SOURCE: Vitori Health

Twenty years ago, nearly two-thirds of doctors were independent practitioners. Today, only one-quarter remain independent.

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Government Sponsored Adverse Selection

Wednesday, July 13th, 2022

Once Upon A Time there was a young man in dire need of medical care but he had no insurance………….

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Law Firm Manages & Reduces Risk For RBP Plans

Tuesday, July 12th, 2022

Protecting patients,
health plans and insurers
across the U.S.

“We engaged Koehler-Fitzgerald in 2015 to represent covered employees of health plans we provide administration to that have adopted reference based pricing. They have been very responsive to the needs and questions presented by plan sponsors, plan members, and our staff. Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. Knowing that every participant has legal representation from a high quality, experienced law firm provides our client plans and employers confidence that their employees will be properly protected from the many aggressive balance billing practices that a small portion of hospitals and other medical providers attempt to employ. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.” – Jim Farley, J.P. Farley Corporation

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Poll – 99.999% of Americans Hate Their Health Insurance

Tuesday, July 12th, 2022

A national poll conducted by the Molly Mulebriar organization found 99.99999% of Americans hate their health insurance. The primary reasons cited include affordability.

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Asserta Seeking Investors @ $7.95 Per Share

Monday, July 11th, 2022

Asserta is offering investors an opportunity to share in a fast growing segment of the American health care system of finance providing employers significant savings on health insurance costs while removing financial barriers and improving member experience for working Americans ………………

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Specialty Drugs Are Bankrupting Health Plans

Sunday, July 10th, 2022

Specialty Drugs Have Consequences 

During the interview process Joe Sixpack learns the position pays $35,000 plus benefits. Little does the employer or Joe know the true cost was going to end up being $650,000…..the equivalent of 18 jobs………..so to keep from bankruptcy the employer must reduce his workforce by 18 (hopefully non-essential) employees and freeze wages for everyone else ………….or move his manufacturing business to China and his $685,000 per year employee to unemployment.

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Voya Health Solutions* Expands Stop Loss Presence in The Mid-market

Sunday, July 10th, 2022

MyHealthGuide Source: Voya Health Solutions*, 7/5/2022

Voya Health Solutions* is pleased to announce their continued expansion into the mid-market beginning with quoting on July 1, 2022.

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The Firemen Are Arsonists

Saturday, July 9th, 2022

“The supposed firemen are arsonists…getting rescued and then robbed shouldn’t happen”.

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Finally, A Wellness Program That Makes Sense

Friday, July 8th, 2022

Rancho Pescadero Wellness Center offers a unique approach to wellness…………….

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Questions For Non-PBM, PBM Experts

Friday, July 8th, 2022

This blog entry is directed towards PBM experts who are not PBM’s or employed by a PBM. We are searching for the truth about the deep black vortex of the PBM world……………

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Carving Out Specialty Drugs May Have Consequences

Thursday, July 7th, 2022

“Reimbursements for overrides are taxable if not provided a written plan as required by Code Section 105. If taxable, reimbursements should be reported on employee W-2s and all applicable income and employment taxes should be withheld and reported as required by the IRS….”

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The RBP Okey-Doke

Thursday, July 7th, 2022

“Pssst….Godfather, We’ve Been Exposed!

The following account is based on a true story.

If a Reference Based Pricing plan pays medical caregivers 120% of Medicare, what is the Plan Sponsor paying?

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Brokers Rejoice! Compensation Disclosure Not Required For Non-ERISA Groups

Wednesday, July 6th, 2022

“Prudent plan fiduciaries will establish and adhere to a formal, written policy to ensure compliance with the New Disclosure Rule. Indemnification and limitation of liability provisions in service provider contracts should also be revisited relative to this new rule.”

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Texas School District Wins “Highest Cost Health Insurance” Award

Monday, July 4th, 2022

Eagle Pass Independent School District has got to be paying more for health insurance than any other school district in Texas…………………..

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Aldeen’s Sunday Morning Bathroom Read – Happy July 4 Edition

Monday, July 4th, 2022

By Doug Aldeen

Sunday morning bathroom read (Happy 4th of July): Slowly but surely (more like a glacial pace) the python like grip of the industrial medical sick complex is loosening… .

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Elected Official Mad As Hell – Hospital Cartel Crushing Middle Class

Monday, July 4th, 2022

“Some things are worth getting mad about. The hospital cartel is using taxpayer dollars to help crush the middle class and rob lower-income families of upward mobility…………Wealthy hospitals took billions of taxpayer dollars meant to protect struggling hospitals — and then some billed poor families or even sued patients.” – State Treasurer Dale R. Folwell, CPA

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Bella, Erec and Lotta

Sunday, July 3rd, 2022

 

Dogs are “superior smellers” and are already used to detect what the human nose typically cannot from diseases, such as Parkinson’s, cancer and diabetes, to drugs and explosives in public places, according to the American Lung Association.

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Free Health Care Por Los Mojados

Sunday, July 3rd, 2022

California will become the first state to remove immigration status as a barrier to health care, making all low-income illegals eligible for state-subsidized healthcare regardless of age.

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Dr. Banting Patented Insulin Over 100 Years Ago For $1. What Happened?

Sunday, July 3rd, 2022

4 Out Of 5 Americans With Diabetes Went Into Debt To Pay For Insulin, New Survey Shows

By Deb Gordon

Amidst rising inflation, Americans are feeling the squeeze of higher prices on everything from gas to groceries. But when inflation bumps into the already rising cost of drugs such as insulin, the impact can be serious and the stakes are high.

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More Plan Sponsors Eye The Canadian Connection

Saturday, July 2nd, 2022

“What! I thought It was The French Connection!”

county government in New York has been accessing Canadian prescription drugs through their self-funded health plan since 2004 with savings in the millions of dollars. Now we see more employers considering the same by moving away from traditional Predatory Business Models (PBM’s) as drug prices reach unaffordable levels in this country.

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Searching For The Perfect TPA

Saturday, July 2nd, 2022

We are looking for the perfect TPA. Some of the qualifications are memorialized here: Selecting a Third Party Administrator.

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Predatory Business Model (PBM) – The Case of The Missing 40%

Saturday, July 2nd, 2022

Holms & Watson Remain Stumped

SOURCE: Vitori Health

report by the PBM Accountability Project reveals the details of PBMs’ “evolving business models and revenue.” Despite the available financial data, the authors could not identify “the source of nearly 40% of PBMs’ total gross profit.”

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Which Drug Would You Buy?

Friday, July 1st, 2022

DRUG A – This One Costs $683

 

 

 

 

 

 

 

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The Tale of Two Underwriters

Friday, July 1st, 2022

By Bill Rusteberg

“What color is that orange?” asks the first underwriter. “It’s yellow!” says the second underwriter. “It can’t be! It’s an orange!” responds the first.

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