Your groups could be saving 43% on health benefits by utilizing an ICHRA.
Continue reading Save 43% On Health Benefits Using An ICHRA?Month: February 2023
When I Grow Up I Want To Be A PBM
Holy Smoke! I’m in the wrong business………………..
Continue reading When I Grow Up I Want To Be A PBMFlorida Blue Cross ASO Contract Publicized On The World Wide Web
Blue Cross ASO Agreement with a Florida school district is posted on the world wide web. Now that it’s posted here let’s see how long it stays in the public domain.
Continue reading Florida Blue Cross ASO Contract Publicized On The World Wide WebThe Profession Formerly Known As Medicine
To estrange themselves further from their calling, doctors bow as never before to the state and the corporation.
Continue reading The Profession Formerly Known As MedicineMilliman Report On ICHRA’s
An ICHRA is by definition a group health plan providing a superior method of health care finance for plan sponsors………. for a lot of reasons.
Continue reading Milliman Report On ICHRA’sHave You Ever Been A Child And Been Told No?
Within 24 hours of posting a link to a copy of Texas A&M’s BCBS ASO Agreement it has been removed from the internet. The Cone of Silence continues………………..
Continue reading Have You Ever Been A Child And Been Told No?Blue Cross Tells Client To Stick It
Suit Against Anthem Exposes Conflict Over Health Claims Data
Article Referred By C. Smith, M.D.
An employee health plan sues its health insurance administrator for refusing to turn over claims data that would allow the employer to verify the accuracy of charges against its self-funded health insurance plan. Medical supply vendor Owens & Minor says Anthem Blue Cross and Blue Shield has refused to provide it with claims data since 2021 as required by federal law. Anthem says its claims data involves proprietary arrangements that it doesn’t want to make public. Several similar lawsuits have been settled out of court, with details hidden behind non-disclosure agreements.
Continue reading Blue Cross Tells Client To Stick ItTexas Hospital Association Opposes House Bill Because Consumers Are Too Dumb
The Texas Hospital Association has concerns, including that providing itemized invoices for every patient’s bill would be costly and time-consuming.
Continue reading Texas Hospital Association Opposes House Bill Because Consumers Are Too DumbAldeen’s Sunday Morning Bathroom Read
Doug Aldeen• ERISA Healthcare Attorney and General Counsel
The state of Connecticut plans to erase $2 billion in medical debt for its residents.
Caveat Emptor and Key Inquiries: 1) Determine the original price of the medical services and 2) How many individuals were otherwise eligible for financial assistance? Perhaps $20mm is still overpaying these hospitals…
“No one wakes up and says, ‘I want to go to the hospital,'” said Ayesha Clarke, interim director of the Hartford-based nonprofit Health Equity Solutions. “However, when it happens, seeking care should not result in a lifetime of financial hardship.
Continue reading Aldeen’s Sunday Morning Bathroom ReadDid You Read The Contract? Then Why Did You Sign It?
It’s been our experience over the years most Plan Sponsors never read their TPA administrative agreements. As an example, some years ago a client approved their ASO agreement without first allowing us to review it as was required under our management agreement. They screwed themselves and I had to tell them they screwed themselves. Sugar coating has never been our style.
Continue reading Did You Read The Contract? Then Why Did You Sign It?School District Still Undecided On Choice of Insurance Advisor
The Mercedes Independent School District can’t decide what to do…………….
Continue reading School District Still Undecided On Choice of Insurance AdvisorInsurance Consultant Fires Client
Humana to Exit Employer Group Commercial Medical Products Business
Article Referred By Dan Meylan
LOUISVILLE, Ky.–(BUSINESS WIRE)– Humana Inc. (NYSE: HUM) today announced that it will be exiting the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded and Federal Employee Health Benefit medical plans, as well as associated wellness and rewards programs.
Continue reading Humana to Exit Employer Group Commercial Medical Products BusinessIs A “Cash Pay Revolution” Coming For Hospitals?
“The market is going there,” said Larry Van Horn, associate professor of management, law, and health policy and executive director of health affairs at Vanderbilt University. “You’ve got direct primary care, you’ve got physicians going and moving into cash pay. You’re gonna have to sit there at some point and say, ‘Wait a minute, they’re taking my business.'”
Continue reading Is A “Cash Pay Revolution” Coming For Hospitals?Cash Pay Health Plans Enjoy Explosive Growth
“Employers who are leveraging these cash pay strategies are saving so much money that they can offer healthcare benefits at no cost to the employee, no employee premiums and no out-of-pocket expenses like copays and deductibles.
Continue reading Cash Pay Health Plans Enjoy Explosive GrowthAssured Benefits Administrators (ABA) Experiences Record Growth
We’ve experienced record growth over the past 24 months, and this has produced opportunities for us to better scale our business.
Continue reading Assured Benefits Administrators (ABA) Experiences Record GrowthConsumer Driven Healthcare In Action
Patient refuses to pay $75 for a two minute doctor visit. If more patients questioned what things cost before receiving services there would be no such thing as a balance bill. And it would be a good first step towards solving the high cost of health care in this country.
Continue reading Consumer Driven Healthcare In ActionDead Men Don’t Talk, Except When They Do
“I’m a little confused, how long have you been dead?” I asked in an open ended way.……………………..“Oh well now. A while. It must be a while.” The gentleman replied, with hestitation.
Continue reading Dead Men Don’t Talk, Except When They DoAndy Is A Lucky Man
During the 17-hour operation, surgeons removed Andy’s diseased organs. He then received the following deceased donor’s organs all together and at the same time: liver, stomach, pancreas and duodenum (pancreaticoduodenal complex), spleen, small intestine and right colon.
Continue reading Andy Is A Lucky ManPublic Bidding – Wasted Days…………
This is why we don’t bid on insurance consulting services………………..
Continue reading Public Bidding – Wasted Days…………The Future Of Employer Sponsored Health Care Financing
Cash pay health plans, funded through employer sponsored plan assets, are the future of group health care benefits for working Americans. Savings over insurance based health care are 50% and more.
Continue reading The Future Of Employer Sponsored Health Care FinancingCash-Pay Healthcare Startup Raises $24 Million To Support Explosive Growth
“I just do not see the value of insurance if essentially I’m paying four times more to use it on top of paying a monthly premium and on top of marching towards a deductible,” Edwards said. “It is no longer a good value proposition.”
Continue reading Cash-Pay Healthcare Startup Raises $24 Million To Support Explosive GrowthCash Pay Health Insurance Service Now Valued At $1 Billion
The way it works is that Sidecar issues its insured members what’s basically a debit card that they use to pay for care, prescriptions, and consultations directly. The money comes from Sidecar’s claims accounts and is paid directly to doctors.
Continue reading Cash Pay Health Insurance Service Now Valued At $1 BillionTen Years In Solidary Confinement With An Insurance Agent
Peter Zeihan Sponsors MedShare Charity
Here at Zeihan On Geopolitics we select a single charity to sponsor. We have two criteria:
Continue reading Peter Zeihan Sponsors MedShare CharitySneaky Underwriting – Who Let The Dogs Out?
Retrospective underwriting can be a powerful marketing strategy. It has been used in the past with good success – write new business with scant regard of traditional underwriting parameters. In nine months you know what your picked up. At 12 months you run off the dogs and keep the rest.
Continue reading Sneaky Underwriting – Who Let The Dogs Out?TRS ActiveCare Premiums Underfund Claims
Will the state continue to make up the shortfall for the TRS ActiveCare government health plan? Commercial carriers operating in the real world competing for Texas school business don’t enjoy that advantage. So how can the commercial carriers and third party administers compete? Sneaky underwriting?
Continue reading TRS ActiveCare Premiums Underfund ClaimsTexas Shared Savings Bill Will Turbocharge Cash Pay Health Plans
So far there have been over 250 insurance related bills introduced in this Texas legislative session. We are seeing quite a few bills that will impact the growing market trend towards health care pricing transparency. Many of these bills will benefit Cash Pay Centric Health Plans.
Continue reading Texas Shared Savings Bill Will Turbocharge Cash Pay Health PlansPPO Contracts Will Never Be The Same Again
If passed this legislative session, Texas HB 711 will forever change manage care contracts. Can you hear the BUCA posse thundering towards the upcoming sub-committee hearing…….?
Continue reading PPO Contracts Will Never Be The Same AgainTexas Eyes Cash Pay Health Plan Legislation?
Texas HB 633, if passed during this year’s legislative session, will provide broad application for Cash Pay Centric Health Plans, a growing market phenomenon. Cash pay health plans are the future of health care finance.
Continue reading Texas Eyes Cash Pay Health Plan Legislation?Texas A&M Medication Assistance Program
Texas A&M offers a medication assistance program for uninsured and underinsured Texans to obtain affordable prescription drugs through pharmaceutical patient assistance programs and foundation money.
Continue reading Texas A&M Medication Assistance ProgramTRS ActiveCare To Consider Change In PBM Tomorrow
TEACHER RETIREMENT SYSTEM OF TEXAS MEETING BOARD OF TRUSTEES
AGENDA February 16, 2023 – 12:00 p.m.
Discuss and consider selecting a pharmacy benefit administrator(s) (PBMs) to improve and enhance financial performance and services for public education employers, employees, retirees, and their families participating in the TRS-Care Standard, TRS-Care Part D (solicited as TRS-Care Indirect EGWP with Wrap PDPs), and TRS-ActiveCare……..
Continue reading TRS ActiveCare To Consider Change In PBM TomorrowHospitals Will Be Insurer of Last Resort For 33% Of Oklahomans
The following article describes the plight of one third of the population of Oklahoma who are on target to lose their Medicaid health insurance this year. The article does not mention 100% of those affected by the Medicaid cut will qualify for free hospital care under IRC 501r…………….and guess who is going to pay for all of this……………
Continue reading Hospitals Will Be Insurer of Last Resort For 33% Of OklahomansNurse Practitioner Claims Have Increased Sharply
NP practice owners assume the liability exposures of their practice, including those of their employees and independent contractors…………….evolving state licensure laws permitting NPs to practice more independently have contributed to the increase in percent and severity of claims.
Continue reading Nurse Practitioner Claims Have Increased SharplyHelping Physicians Can Get It Right The First Time
Article Referred By Brent Evans – Sundown, Texas
West Texans are fiercely independent. There’s nothing a West Texan can’t figure out. When something breaks they don’t call for help, they fix it themselves. If they don’t know how, they figure it out. This fellow is no exception.
Continue reading Helping Physicians Can Get It Right The First TimeFour School Districts Win Case Against Hospital System – “You Can’t Have Your Cake & Eat It Too”
Pottstown’s superintendent Stephen Rodriguez said he was thrilled by the decision. “This decision is validation that our concerns with Tower Health were appropriate. They did not meet the measure of the law and should be paying their fair share of taxes and I look forward to them paying up.”
Continue reading Four School Districts Win Case Against Hospital System – “You Can’t Have Your Cake & Eat It Too”Tough Negotiator
By Bill Rusteberg
“Do we have a Francisco Ybarra working for us?” asked the Sister. “Yes, he’s our grounds keeper” replied Maria in HR. “Ok, tell him Friday is his last day!” said the Sister of Charity……..“Now about this renewal offer……”
Continue reading Tough NegotiatorTexas Bill Would Open New Opportunities For Texas Insurance Agents!
Texas Bill Would Require Law Enforcement to Carry Liability Insurance
A bill introduced last week by a Texas lawmaker would require law enforcement officers in the state to carry liability insurance as a condition of employment.
Continue reading Texas Bill Would Open New Opportunities For Texas Insurance Agents!Professional Governmental Underwriters LLC
Professional Governmental Underwriters, Inc. is a full-service risk management company dedicated to assisting public, educational and non-profit entities in the management of their professional liability exposures. Current operations are dedicated to underwriting and marketing Public Officials Liability, Law Enforcement Liability and Educators Liability insurance.
We are dedicated to providing state-of-the-art professional underwriting management and loss control advisory services on behalf of our designated carriers. We operate through a network of professional producers who seek specialized services for their public, educational and non-profit entity clients.
Continue reading Professional Governmental Underwriters LLCRBP Direct Hospital Agreements – Be Careful of What You Hope For
By Bill Rusteberg
A self-funded plan sponsor has direct agreements with several San Antonio hospital systems. These direct agreements are a straight, flat rated Medicare based fee schedule without the usual managed care outliers such as escalator clauses, stop loss provisions, etc.
Continue reading RBP Direct Hospital Agreements – Be Careful of What You Hope ForNon-Profit Hospitals Want Their Cake & Eat It Too
Montana’s Tax-Exempt Hospitals Oppose Increased Oversight by State Officials
More than half of acute care hospitals in the United States are nonprofit hospitals, which must record community benefits — such as covering a patient’s bill or offering mental health services at a loss — with the IRS for their tax exemptions. But federal rules around how hospitals tally charitable acts are broad, with oversight lacking. Pressure for more transparency has mounted as about 6 in 10 adults in the U.S. with household incomes below $40,000 have medical debt, and altogether Americans owe an estimated $195 billion or more.
Continue reading Non-Profit Hospitals Want Their Cake & Eat It TooUHC Solves Healthcare?
UHC Tacitly Admits Not All Providers Cost The Same………………………
How to save money on health care? First, identify all the cheap providers. Second, from that list pick out the ones that graduated at the top of their class. Then bundle them all together and brand them the Gold Star Value Network.
Continue reading UHC Solves Healthcare?The First $250,000,000 Is On You, The Next $2,500,000,000 Is On Us
In Turkey, compulsory earthquake insurance is offered to the public via a catastrophe insurance pool, which has a claims paying capacity of nearly $2.5 billion, based on its 2021 reinsurance renewal.
Continue reading The First $250,000,000 Is On You, The Next $2,500,000,000 Is On UsIf Healthcare Was Honest
Nick Freitas Has Some Advice
The Defense Collaborative
Headquartered in St. Louis, Missouri, The Defense Collaborative is a fresh take on risk / claims / liability / insurance / defense. It is a collaborative networking and education platform facilitating the creation of relationships through networking events, CLE/CE approved seminars and non-CLE/CE approved seminars. Fun culture. Safe environment to gain feedback. No gains other than to facilitate meaningful connections through education/scenarios.
Continue reading The Defense CollaborativeThe Existential Threat of Greed in US Health Care
“A patient was billed $73 800 at the University of Chicago for 2 injections of Lupron depot, a treatment for prostate cancer, a drug available in the UK for $260 a dose………….”
Continue reading The Existential Threat of Greed in US Health CareSCHOOL INSURANCE NEWSLETTER
When comparing insurance costs, using premiums does not present a realistic comparison; use rates. Divide the premium by the exposure (values, number of vehicles, cost new of insured vehicles, number of students).
Continue reading SCHOOL INSURANCE NEWSLETTERLasers Can Be A Plan Sponsor’s Best Friend
By Bill Rusteberg
Lasers have been unfairly treated and it’s time to show a little respect!
Continue reading Lasers Can Be A Plan Sponsor’s Best FriendPatient Has Last Laugh
Blue Cross Discloses Negotiated Rates With In-Network Providers
The Transparency in Coverage Final Rule and Texas House Bill 2090 require disclosure of the negotiated rates with in-network providers and the historic allowed amounts paid to out-of-network providers, for all health plans available to employers. Files containing this information for the plans covered are published on this page.
Continue reading Blue Cross Discloses Negotiated Rates With In-Network ProvidersKing Murray – The Most Outrageous Insurance Salesman Ever!
Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!
Continue reading King Murray – The Most Outrageous Insurance Salesman Ever!Brownsville ISD Trustees Debate The Value Of Their Health Insurance Broker
Brownsville ISD board members debate the value of their health insurance broker at a Brownsville ISD Insurance Committee Workshop on May 13, 2020.
There is a difference between managing risk and servicing risk. Legacy health insurance brokers provide the later. New era health insurance brokers provide the former leaving TPA’s to service the risk.
Continue reading Brownsville ISD Trustees Debate The Value Of Their Health Insurance BrokerNed Ryerson
Butler: Let’s Make Drug Pricing So Complicated No One Understands It!
By Josh Butler
I’ve got a brilliant idea….What is it? Let’s make buying prescriptions sooo complicated, no one will ever be able to understand it….
Continue reading Butler: Let’s Make Drug Pricing So Complicated No One Understands It!Liberty Mutual Rescues Suicidal State Farm Customer
“Like a good neighbor, State Farm is there – and here and in my bed with my wife!”
Continue reading Liberty Mutual Rescues Suicidal State Farm CustomerInsurers View Teslas As Throw Away Vehicles
Tesla dispute – top auto insurers writing off rather than repairing crashed Tesla EVs
by Mary Or 31 Jan 2023
Auto insurers have been writing off crashed Tesla EVs and sending them to salvage auctions instead, deeming many too expensive to repair.
Continue reading Insurers View Teslas As Throw Away VehiclesGovernment’s Two Step Solution To Solving Health Care
(1) Crank up the printing presses and gift more money to health insurance companies to pay for out of control health care costs and (2) Gift stolen wages from working class Hyphenated-Americans to health insurance companies to pay for out of control health care costs.
“Bill provisions include making enhanced subsidies (OTHER PEOPLE’S MONEY) for Affordable Care Act Health Insurance Marketplace coverage, extended through 2025 in the Inflation Reduction Act, permanent; designating the second-lowest-cost Gold plan the benchmark plan upon which premium subsidies (OTHER PEOPLE’S MONEY) are based; and increasing the value of cost-sharing reduction (CSR) assistance for those with income between 100 and 250 percent of FPL (Federal Poverty Level) while expanding eligibility for CSR assistance to people with income up to 400 percent of FPL.”
Continue reading Government’s Two Step Solution To Solving Health Care