“MSL (Medical Stop Loss) captives that employ sound risk selection (membership) guidelines and have a platform based on medical cost and risk reduction initiatives will continue to outperform the traditional stop-loss market and deliver the best results for their members.”
Continue reading Medical Stop Loss Captives On Course For 25% Market ShareMonth: December 2022
95% of Plan Sponsors Cling To The Past
Government Backed Stocks?
Group Health Insurance Is Broken, So We’re Fixing It
Everlong is a better way to purchase group health insurance.
Everlong is an exclusive, member-owned medical Captive that enables employers to offer the same level of group health benefits at the lowest cost possible AND improve the health of their employees.
Continue reading Group Health Insurance Is Broken, So We’re Fixing ItHow To Make Money While Sleeping
Send in a referral and lock yourself in as Agent of Record. Earn big bucks while sleeping, playing golf, or cruising towards Tahiti for a week of fun and umbrella drinks…………..A day in the life of an insurance agent has never been better…………..
“Selling ain’t hard when you know how!” – Victor Antonio
Continue reading How To Make Money While SleepingPele & Mike The Insurance Guy
By Bill Rusteberg
Upon learning of Pele’s passing today I found myself reminiscing about a chance encounter I had with Pele’s life insurance broker several years ago.
Continue reading Pele & Mike The Insurance Guy95% Of All Medical Providers Agree To Less Pay
“Blue Cross PPO plans have a 5-9% lower total cost of care over the competitor’s average. Nationally, Blue Cross PPO members have access to 95% of doctors and 96% of hospitals.”
Continue reading 95% Of All Medical Providers Agree To Less PayLubbock Physician Offers Best Healthcare At The Lowest Price
The Best Healthcare at the Lowest Price – Ready To Begin Your Healing Journey?
WE BELIEVE IN RELATIONSHIPS AND WANT TO TALK WITH YOU TODAY!
Together We Can Create A Customized Plan For You For The Best Healthcare at The Lowest price. Leave your phone number and we’ll have one of our skilled team members call you as soon as possible.
Ben Edwards, M.D. – FOUNDER AND MEDICAL DIRECTOR – Meet Dr. Ben
Continue reading Lubbock Physician Offers Best Healthcare At The Lowest PriceBlue Cross Fails To Control Health Care Costs Under Federal Employee Health Plan
Blue Cross announces a 2023 rate increase for millions of federal workers proving once again managed care’s failure to control health care costs.
When it comes to controlling costs size doesn’t matter.
Meanwhile in hamlets across the fruited plain, small to medium size employers, led by health care revolutionaries, with a flaming torch in one hand and the Health Rosetta in the other, are proving health care can be fixed by lowering costs and increasing benefits at the same time.
Continue reading Blue Cross Fails To Control Health Care Costs Under Federal Employee Health PlanDirect Med Clinic – San Antonio
The Power of Pooling
AGRiP energizes the power of pooling, making member organizations more effective, collaborative and informed (Home – Association of Governmental Risk Pools (agrip.org)
Continue reading The Power of PoolingSilver Loading – Squeezing Uncle Sam For More Free Money
Insurance company mathematicians have calculated a method to squeeze millions more in federal subsidies. It’s called Silver Loading………………
Continue reading Silver Loading – Squeezing Uncle Sam For More Free MoneyAldeen’s Sunday Morning Bathroom Read
Sunday Morning Bathroom Read ( Paul Harvey “The Rest of the Story” edition):
Continue reading Aldeen’s Sunday Morning Bathroom ReadSaving Phony Money Costs Real Money – The % Of Savings Scam
The boys in the backroom nominate UnitedHealth for the Victor Lustig award!
Continue reading Saving Phony Money Costs Real Money – The % Of Savings ScamSalud!
“They’re living healthier lives. We’re saving money, we’re able to share those cost savings back with the employees by keeping their premiums and their deductibles low,” says Brown. “It just becomes this flywheel where everybody wins.”
Continue reading Salud!Blue Cross Says You Can’t Always Get What You Want!
The hospital bill was $674,856: Why did the state pay Blue Cross over $2 million?
By John Tozzi
December 14, 2022 at 12:54 PM
New Jersey, which has one of the country’s largest state employee health plans, has an ongoing conflict with Horizon Blue Cross Blue Shield, alleging the insurer failed to deliver on a program designed to reduce health care costs.
Continue reading Blue Cross Says You Can’t Always Get What You Want!ACA RE – The Best Stop Loss Policy Ever?
By Bill Rusteberg
Transferring risk has never been easier. Lasers are no longer relevant and (almost) never a factor. Rate setting becomes a simple process.
Continue reading ACA RE – The Best Stop Loss Policy Ever?Do You Believe Me Now?
Poor Pearl Roberts! No one believed her…………………
Continue reading Do You Believe Me Now?Experience Rating – The Past Dictates The Future
“In our industry we rely on the past to have a glimpse of the future………..”
Continue reading Experience Rating – The Past Dictates The FutureAldeen’s Sunday Morning Bathroom Read
Doug Aldeen – ERISA Healthcare Attorney and General Counsel
Why capitalism needs sick people begs the question:
A): There is no money in being healthy unless it is your own cash;
B): The health care sector of the economy is too big to fail;
MedSave Management LLC
MEDSAVE MANAGEMENT LLC is pleased to announce a new health care plan option members may choose when seeking medical care.
Continue reading MedSave Management LLCCA Insurance Services, LLC
CA Insurance Services, LLC focuses on providing health benefit producers with innovative funding options not available through the traditional fully insured programs offered by national and regional insurance carriers.
Continue reading CA Insurance Services, LLCButler Finds Low Hanging Fruit
Josh Butler discusses strategies to tackle high cost drugs – excellent presentation
Continue reading Butler Finds Low Hanging FruitSan Benito ISD Awards Agent of Record
San Benito Independent School District awards Agent of Record for the district’s employee benefits program.
Continue reading San Benito ISD Awards Agent of RecordTRS ActiveCare Plays Up The SB1444 Poison Pill Provision
QUESTION FOR THE BROKER: How can we secure a firm stop-loss rate for the next plan year? (ASO only)………Can we lock in our liability for the next plan year?
ANSWER: You can’t.
Continue reading TRS ActiveCare Plays Up The SB1444 Poison Pill ProvisionThe Rise of Reference Based Pricing & The Future of Health Care
“A Community Health Plan is currently under development in central Texas. It will incorporate ER, Lab & Radiology, and direct primary care at a capitated rate of less than $125. A cash based reimbursement wrap for all other covered services through a cash pay provider network will cover remaining covered medical services.”
Continue reading The Rise of Reference Based Pricing & The Future of Health CareParametric Insurance
Unlike traditional insurance, which relies on lengthy loss adjustment procedures, parametric insurance pays out when a predefined event occurs as measured by a specified parameter or index.
Continue reading Parametric InsuranceUpstart Drug Pusher Challenges Drug Cartel
Mark Cuban’s Cost Plus Drugs Expands To Employers In Quest To Disrupt Big Pharma
Brian Bushard – Forbes Staff
Dec 10, 2022
Billionaire investor Mark Cuban’s self-titled low-cost pharmaceutical company Mark Cuban Cost Plus Drug Company partnered with a major pharmaceutical company this week as the Dallas Mavericks owner looks to access employer benefit programs and compete more directly with pharmacy giants like CVS, Rite Aid and Walgreens.
Continue reading Upstart Drug Pusher Challenges Drug CartelAldeen’s Sunday Morning Bathroom Read
Doug Aldeen• Healthcare Attorney and General Counsel
Sunday Morning Bathroom Read (Final Jeopardy Edition): This movie line best summarizes a plan sponsor’s response to the Aetna PBM RFP:
Continue reading Aldeen’s Sunday Morning Bathroom ReadRisk Management: “Having The Right Culture Is Key”
Does best in class risk management pivot on personalities?
Before you waste too much time with a prospect, its best to determine up front if they are a fit for your strategies to control and lower risks. Compatibility and shared philosophies should be determined during your first interview (Yes, you are interviewing the prospect but they don’t know it). That meeting will either be your last or it could be the start of something amazing.
Continue reading Risk Management: “Having The Right Culture Is Key”Compassionate Care Plan
Imagine an employer sponsored, tax supported health plan that’s free, covers virtually every needed health care expense, that’s designed specifically for those in immediate dire need of better health care when it’s needed the most, who otherwise would face looming, imminent catastrophic out-of-pocket medical expenses.
Continue reading Compassionate Care PlanWorld’s Top-Selling Drug Going Off Patent Means Big Bucks for Middlemen
AbbVie’s Humira has raked in about $200 billion over its lifetime.PHOTO: JOE BUGLEWICZ FOR THE WALL STREET JOURNAL
As AbbVie’s Humira faces copycat biologics, the biggest beneficiaries will be the middlemen negotiating and dispensing the drugs such as Cigna and CVS.
Continue reading World’s Top-Selling Drug Going Off Patent Means Big Bucks for MiddlemenBupa Arabia
Rx Manufacturer’s Assistance Programs
Attorneys Brady Bizarro and Andrew Silverio discuss manufacturer/copay assistance programs and outline some of the different approaches being utilized to manage specialty drug spending. Also on the agenda is a current lawsuit against one such program administrator, and how the landscape might be shaped in the coming months.
Continue reading Rx Manufacturer’s Assistance ProgramsGovernment To Gift Millions More To TRS ActiveCare?
The amount of $286,337,761 is allocated for the purpose that premiums for TRS and TRS ActiveCare insurance policies not increase as a result of coronavirus-related claims……
Continue reading Government To Gift Millions More To TRS ActiveCare?Bill Introduced Criminalizing Private Health Insurance
It shall be unlawful for:
(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or
(2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
Continue reading Bill Introduced Criminalizing Private Health InsuranceHalf Pregnant Tulip Lovers vs Cliff Dwellers
Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks.
Continue reading Half Pregnant Tulip Lovers vs Cliff DwellersRx Patient Assistance Programs – A Growing Risk Transfer Strategy
Employers, Insurers Use Patient Assistance Programs To Offset Their Own Costs
Rx patient assistance programs become a de facto stop loss policy (and lucrative boon for third party intermediaries facilitating the process). Add in IRC 501r for good measure and a plan can cut costs back to 1980’s levels. Then add in DPC, controlled referrals, and cash pay and you’ve freed up so much money you can buy each employee a Cadillac for Xmas plus a week’s vacation in Tahiti. Life is good.
Continue reading Rx Patient Assistance Programs – A Growing Risk Transfer StrategyMost Brokers & Plan Sponsors Are Paralyzed By Fear
We were reminded today most brokers and plan sponsors are paralyzed by the fear of venturing into the world of Reference Based Pricing.
Continue reading Most Brokers & Plan Sponsors Are Paralyzed By FearLaunch of ‘Business for Medicare for All’
“We are business owners who believe our health insurance costs should not increase every year by double digits. Our payments to profiteering health insurers have swelled as our employees have been offered worse health care coverage. At our companies, rising costs paired with declining performance is unacceptable. So why should we accept this exploitation of our companies from health insurers?”
Continue reading Launch of ‘Business for Medicare for All’Santa Brings Joy To Millions of Americans
A majority of Americans see their wishes come true from open borders, recession, Green New Deal to almost free health insurance, the best gift of all, made possible by giving insurers a direct line to the federal treasury to the tune $30 billion in 2022.
Continue reading Santa Brings Joy To Millions of AmericansPlan Sponsor: “Give It To Me!” Anthem: “Screw You”
“We operate under the belief that vendors don’t want us to know their business because it won’t be good for them, so we remove that barrier as best we can.”
Continue reading Plan Sponsor: “Give It To Me!” Anthem: “Screw You”This Small-Town Pharmacy May Be Model For More Affordable Drugs
Honest Rx operates like any other pharmacy in the United States — with one big exception. It does not accept health insurance.
Continue reading This Small-Town Pharmacy May Be Model For More Affordable DrugsDoctors Revolt Against Hospital System
The Story of Tryon Medical Partners shows us that if doctors don’t like the way a hospital is running their practice, they can leave and be successful.
Continue reading Doctors Revolt Against Hospital SystemMedical Trend Driven By Greed
“Another way hospital systems exploit their growing monopoly power to maximize their profits is a shady practice known as “dishonest billing.” This occurs when big hospital systems buy up small, independent doctor’s offices and take over their billing operations, tacking on additional hospital facility fees, despite the patient never stepping foot inside a hospital and receiving the same service from the same physician.”
Continue reading Medical Trend Driven By GreedMerry Christmas and Happy Holidays! I sincerely wish everyone an enjoyable holiday season. All the best to you and yours – Doug Aldeen
Continue readingDiscount Dental Plan Provides Extra Perks
Taxpayers Gift Hospital $538,000,000 In Return For $49,000,000
I’m gonna make you an offer you can’t refuse. I’ll lend you $538 interest free if you give it back. Capisce? ………. Ok, sure, here’s $49 back, now we’re even.
“Pssst Godfather! Even worse, the $49 is counterfeit manufactured by a chargemaster printing press!”
Continue reading Taxpayers Gift Hospital $538,000,000 In Return For $49,000,000Here’s Your Menu, May I Get Your Drink Orders First?
“Knee replacement? That’s $18,000, tip included. You will find it under “House Specialties” here” said the waitress. “OK Great! I’ll take two of those” says the customer. “And hook me up with a slow drip Miller Lite.”
“I’ll take the bursectomy” says his wife as she elbows her husband with a playful grin. “Does it come with an after dinner sling or is that extra? And I’ll take an Epidural Martini, shaken not stirred.“
Continue reading Here’s Your Menu, May I Get Your Drink Orders First?HB 3752 Authorizes Texas Mutual To Offer Alternative Health Insurance
November 30, 2022
The Texas Mutual board of directors approved the initial steps for creating a health coverage-focused subsidiary. Last year the Texas Legislature authorized Texas Mutual to potentially offer health coverage solutions through a subsidiary that could help the people of Texas and Texas businesses.
Continue reading HB 3752 Authorizes Texas Mutual To Offer Alternative Health InsuranceAWP Can Be 125 X The Drug Cost
“An 80% Discount Off of AWP is Still 24X the Cost of the Medication……”
Continue reading AWP Can Be 125 X The Drug Cost