January 2024 – Risk Managers

Europe’s Largest Company Made Possible By Fat People

SOURCE: Novo Nordisk hits $500 billion in market value as it flags soaring demand for Wegovy, Ozempic (cnbc.com)

Novo Nordisk hits $500 billion in market value as it flags soaring demand for Wegovy, Ozempic

Health Care Pricing Estimates Are Bullshit

SOURCE: Mitigate Partners, LLC | Employee Benefits Consulting

Somehow, hospitals and insurers continue to get away with only providing estimates and not actual prices for their services and procedures. This allows our healthcare system to remain rigged for their profit and to the detriment and demise of patients, families, communities, tax payers, unions, employers, and municipalities across the country.

How to Fix Rural Healthcare: LEAVE US ALONE.

“I left our CAH almost 8 years ago and started a Direct Primary Care clinic. It operates purely in the free-market economy and is thriving. Small regional hospitals are now coming around to my way of thinking and are now beginning to bundle things like radiology studies, and surgery, etc. to compete with each other for cash business, and it’s making them money and saving patients money. These hospitals have to find loopholes in the bureaucracy to do this (the government and the trillion-dollar insurance companies who control the elected officials in the shadows love the status quo and want prices to stay high).“

Gorillas, Chimpanzees & Monkeys

Which one are you, a gorilla, chimpanzee or monkey? And are you a cost containment disruptor? Don’t get too comfortable because your seat at the table is temporary…………..

Doctor Reacts To South Park Medical

While Cartman’s gingervitis might not be real, gingivitis is and there are tons of myths about red/ginger hair and freckles.

Anonymous Hotline Tipster Saves American Healthcare Trillions

“It’s dinner on the East Coast in less than an hour and people are gonna die!…………Sir, we’ve got a boy on the Hot Line and he thinks he knows something……………!

How Much of Total U.S. Health Spending Is Currently Funded By The Federal Government?

The federal government is the largest contributor to total health spending in the country….paid for an eroding American middle class living from paycheck to paycheck………

Mary Lou Got Some Splainin To Do

Mary Lou Retton got $2M from 2018 divorce and maybe millions more in lawsuit over her double hip replacement – yet the Olympic gymnast still raised $500k to cover medical costs after near-death battle with pneumonia………..

If Your Group Health Plan Is Unaffordable………….

If I cannot afford my employer coverage, can I apply for premium subsidies through individual or family ACA plans?

Attention TPA’s, You’re Next!

Will self-funded plans get caught up in carrier and TPA legal battles?

By Chris Deacon, J.D.

On January 12, 2024, the Department of Labor (DOL) filed a complaint against Blue Cross and Blue Shield of Minnesota (BCBSM) alleging a series of violations pertaining to the Employee Retirement Income Security Act of 1974 (ERISA).

30,000,000 Americans Rely On Federally Qualified Health Centers (FQHCs)

By Eric Wicklund

Over 30 million Americans rely on Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and community health clinics for healthcare, often as their only contact point.

Dallas Based Charitable Pharmacy Expands To San Antonio

St. Vincent de Paul (SVdP) is a Dallas-based charitable pharmacy that fills prescriptions and provides free medication for those who otherwise could not afford it. Now, the organization is expanding across Texas and providing medication to those who are homeless or in transitional housing recovering from homelessness through Haven for Hope.

TPA For Mysterious Austin Based Large Group Client Seeks Program Manager

Due to exciting growth, we are looking for a Program Manager to manage a new block of business with a large Client within our organization.

Dallas Entrepreneur Offers FREE Partial Breast Reconstruction Service

“All of them have such a powerful story,” James said of her reconstructive clients. “Some are young, others older…….Being able to do this for them and seeing them heal is so rewarding.”

Hospital Meets With RBP Plan Sponsor

By Bill Rusteberg

A hospital reaches out to a RBP plan expressing their interest in negotiating a direct agreement. That is encouraging since many plan members view the hospital as a preferred hospital in their community.

San Patricio County Considers Terminating Insurance Consulting Agreement

San Patricio County to consider termination of Insurance Consulting Agreement during their Monday, January 29, 2024 Commissioners Court meeting.

Eagle Pass ISD Should Feel Much Better After Reading This………

By Molly Mulebriar

On bended knee we ask, will someone, anyone, please forward this posting to the Eagle Pass Independent School District. You will be doing them a service as they will feel much, much better knowing they are getting screwed less than others.

Government Pays $100,000,000 In Obamacare Commissions During Open Enrollment

CMS highlighted how four in five Healthcare.gov customers were able to find coverage for $10 or less per month for the 2024 plan year after subsidies. The agency also credited the Biden Administration for giving out nearly $100 million in Navigator awards, which lets organizations hire staff to help consumers, according to the press release.

CNN Saves Patient’s Life

Medical experts are scratching their heads over the incredible recovery of a comatose patient on life support who was not expected to survive.

Uninsured, Unable To Stand Upright, Patient Seeks Medical Attention at Outdoor Clinic

Nothing like a fresh air clinic with no wait times, copays, or deductibles to worry about……………

Insurance Company Sues Minneapolis For ‘Negligence’ During George Floyd Riots

“The City’s negligence was a direct cause of the plaintiffs’ damages. The city is liable to the plaintiffs for their damages,” the lawsuit argues.

Government Reports 17% of In-Network Claims Denied

“If you have health insurance through healthcare.gov you have a 1 in 5 chance of having your claim denied.”

Illegal Aliens Sign Up For Free Obamacare in San Antonio?

Outside the NGO processing center in San Antonio Tx, Illegals that have only been in the United States for less than 48 hours were being signed up for free health insurance.

CrowdHealth Isn’t Health Insurance… and Why That’s a Good Thing!

“Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”

22 Men and A Cat

INCREDIBLE STORY from the history pages of Lloyds of London

By Paul Miller

A cat features in this, my favourite story from the Lloyd’s archives. I post it every now and then, for those that haven’t heard it as it’s so extraordinary.

Adios, Es Hora

By Bill Rusteberg

One of the hardest things a consultant can do is fire a client. Today we did just that. It wasn’t an easy decision. This is a client we’ve served for many years, earning deep friendships within the organization that will endure.

Teeny-Weeny PBMs Challenge The Big Boys

Startups promising lower costs and transparency challenge the largest benefit managers………….

Sherlock Holms Of Insurance

By Paul Miller

Sir William Charles Crocker was a man often referred to as the “Sherlock Holmes of Insurance”.

I Just Might Be A Psychopath

By Andy Schoonover, CEO CrowdHealth

Here is a story about how I just might be a psychopath (and how I saved 88% on my medical bill in 12 minutes).

Lloyds of London

“We now have our cars insured by Lloyd’s of London. I do not anticipate any further insurance problems” – Martin Luther King

RiskManager.us Invests In Latest Technology

RiskManagers.us official demonstrates latest cutting edge technology in front of stunned audience.

The Best Work Comes Out of Great Relationships

By Bill Rusteberg

As a self employed insurance agent I’ve worked with hundreds of clients over the past 50 years, the result of calling on thousands more in prospecting efforts to gain more business. I’ve met all types of personalities, developing a skill few have. Understanding motivation, goals and interests is secondary to understanding moral and ethical values of those you strive to do business with.

Rural-Urban Healthcare Access Gap: It’s All About The Fixed Costs

“Recognizing the key challenge of paying for the fixed costs of rural healthcare practices and facilities, government-induced and -subsidized capacity should focus on meeting what rural residents need the most, such as supporting primary care……….”

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

In August of 2023, Advent Health fled a lawsuit alleging that MultiPlan’s business model of contracting with fellow payers and aggressively repricing out-of-network service payments is anticompetitive under Section 1 of the Sherman Act.

Will Government Grant Pardons To Death Row Inmates?

Government has been known to mandate certain life saving vaccines quickly, without years and years of clinical trials hobbled by a burdensome administrative state about as efficient as the U.S. postal service. Cancer patients dealt a death sentence wonder why a vaccine that’s been around for over a decade with a promising cure rate can’t be made widely available right now, before death do they part cancer’s death row.

Bernie Sanders Proposes Subpoenas of CEOs of J&J, Merck On Drug Prices

U.S. Sen. Bernie Sander stares to the front and leans into his microphone at a hearing — politics coverage from STAT

“Considering that drugs like Eliquis have net prices that are a fraction of the list prices – with so many of those rebates going to government programs – if the committee wants answers for why the prices are so high, maybe instead of pharma execs, they should subpoena a mirror” – Antonio Ciaccia

ValueHealth Benefit Administrators

Terri Raimondi – Senior Vice President, Business Development and Marketing

Benefit Administrators is progressive and committed—an authoritative Third Party Administrator known for flexible, innovative solutions and unparalleled customer service.

Lose Weight With GLP-1 Medication Prescribed Online & Delivered

Want one of those expensive employer paid weight loss drugs that’s bankrupting health plans without having to go through all the usual hassles of taking time off for work to see a doctor for a prescription? Now you can……………..

The Silent Epidemic Eating Away Americans’ Minds

By Marina Zhang

Billy was a bright 10-year-old boy with two Ivy-League-educated parents. He was book smart—got straight A’s in school—but lacked street smarts.

Insurance Coverage Makes Common Generic Drugs More Expensive

“Congress and state legislatures should consider allowing insurance plans not to cover common generic drugs. This move would fundamentally resolve the spread pricing problem created by pharmacy benefit managers, eliminate wasteful spending on these drugs and lower insurance premiums for all.”

The Baby Survived But the Mom Almost Had a Heart Attack When She Got the Hospital Bill

By Marshall Allen

‘That’s an incredible victory! But like many of these wins, it’s bittersweet, because it exposes an outrage. Neither the hospital nor the insurer had been complying with the Illinois law.”

US Drug Prices Are 8x the Cost in Peer Countries for Some Drugs

By Kelsey Waddill

For nine out of ten Medicare-negotiated drug prices, the US still faced higher costs than peer countries even with rebates.

Maintaining Access to Rural Healthcare Amid Closures

The cost of delivering quality care is higher than ever, while payers are looking to downsize reimbursement rates as much as possible.

The High Cost Of Weight-loss Drugs Is Threatening Coverage Altogether

By Lucy Peterson
January 16, 2024 at 08:45 AM

With the price of GLP-1s reaching well over $1000 a month, local officials are warning that rising costs threaten to quickly drain government spending accounts.

Assessing Early Experience With Arbitration Under The No Surprises Act

What is the No Surprises Act? “It’s a law that transfers balance billing liability from plan members to plan sponsors under certain circumstances gifting the balance biller a much better opportunity to recoup from a deep pocketed plan sponsor than from a Joe Sixpak.” Bill Rusteberg

Lloyds of London

By Paul Milller, London Market Insurance

In April, 1936, a piece of paper was passed around the Underwriting Room at Lloyd’s of London bearing at the top the notation “Queen Mary — £4,800,000”.

The Most Powerful Natural Pain Killer In The World?

You saw the media frenzy on Fox. – After 11 years of private testing, Conolidine “Nature’s Morphine” is now legal worldwide.

After a 100,000 person clinical analysis Conolidine is now certified as the most powerful natural pain reliever in the world…. Boasting pharmaceutical level relief with no negative effects.

Next Insurance

Unfair Business Tactics

By Bill Rusteberg

Health insurance brokerage is nasty business. It’s a replacement sale reliant upon destroying relationships. For some anything goes, colored under the heading “All Is Fair In War.” The good news is sometimes the good guys win. So how are they able to do that?

One Drug, Five Prices

Tom, Dick and Harry go to the same drug store to pick up the same drug, through the same PBM, on the same day. Each is asked to pick their price behind doors number 1, 2, 3, 4, or 5. Tom picks Door #1 much to the pharmacist’s displeasure. Dick picks Door #3 as the pharmacist nods approval. Harry picks Door #5 and the pharmacist belts out a joyful YES!

The Dark History Of A Pharmaceutical Company

Bayer is a German multinational pharmaceutical and biotechnology company and is one of the largest pharmaceutical companies and biomedical companies in the world.

Wholesale Generic Drug Pricing Will Amaze You & Piss Off Your PBM

ScriptCo is a membership-based pharmacy making prescription medications more affordable for everyone.

Smart Pharmacy Plan Bypasses Middle Men

SOURCE: Oniline Pharmacy – Employer Solutions | DiRx Health

“In bypassing multiple middlemen in the distribution chain, DiRx is streamlining the path between the manufacturer and the consumer…………………..”

Top Dog Or Underdog? Bargaining Power In Healthcare

By Ge Bai – Contributor|HEALTHCARE

In healthcare and elsewhere, the price of services and products is determined by the relative bargaining power between the buyer and the seller. A top dog can afford to walk away without entering the transaction, whereas an underdog cannot. Being the top dog or the underdog makes all the difference for prices in healthcare.

The Parable of The River

“One day, a group of villagers was working in the fields by a river. Suddenly someone noticed a baby floating down the river………….”

2024 RiskManagers.us Fee Schedule

“How Much Do You Charge?” is a question that invariably enters the conversation when meeting a prospective client for the first time. So in 2014 we published our fee schedule for all to see and marvel.

Marpai Hires The Best of The Best

Marpai Hires John Powers as President

MyHealthGuide Source: Marpai (Nasdaq: MRAI), 1/12/2024

NEW YORK — Marpai, Inc., an independent national Third-Party Administration company transforming the $22 billion TPA market supporting self-funded employer health plans, announced the appointment of John Powers as the Company’s President. Powers is an accomplished healthcare benefits executive with over 30 years’ experience. Powers was previously CEO of Homestead Smart Health Plans.

The Affordable Care Act Hasn’t Done Squat

Insurance protects one from loss. But how much of the loss is covered?

Helping People Feel (and look) Better In Deep South Texas

“The Lower Rio Grande Valley, like many other communities in the United States, is facing a diabetes epidemic. The growing health crisis of widespread diabetes threatens individuals, families, the health system, and the prosperity of the Rio Grande Valley community.” SOURCE: Preventing Diabetes in the Rio Grande Valley – FSG

Turtles, Birds And Rabbits

Will a full-body MRI scan help you or hurt you? A doctor gets his own scan and finds out…………….

Whiny College Professor Hates Aetna

A WHINY COLLEGE PROFESSOR POSTED THE FOLLOWING ON LINKEDIN:

“Stanford University moved its health insurance from California Blue Shield to Aetna. It is now January 9, and I have yet to receive a card showing my member number, which is the evidence of coverage virtually every pharmacy and medical provider demands in order to get service.”

Marpai Stock Tanks Despite New Management Team

9:30 CST 11 Jan 2024

By Bill Biloselhigh

The market could care less there’s new management in place at Marpai…….

American Health Care Has A Moral Problem

By Marshall Allen, Author – “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win”

Early in my journalism career, I wrote about murder, drug deals and domestic violence. That’s wrongdoing our country rightly condemns.

Money Affects Behavior

Back in the day health insurance didn’t finance loan free loss, it reimbursed loss.

ICHRAs Designed to Minimize Offloading Bad Experience

By William G. (Bill) Stuart

Can companies shed bad claims risk by moving to an ICHRA to fund their employees’ medical coverage? Yes. But the law minimizes the opportunity.

Differences In The 30 Day Cost of Two Prescription Drugs

“As the call for clearer prescription drug pricing has grown, there could be significant shifts in the prescription drug landscape in the coming years … Concerns have arisen around manufacturers potentially raising costs for non-Medicare plans to recoup lost revenue from IRA price negotiations. … There are several situations that could result in increased or decreased costs for plan sponsors in addition to potential price shifting.”

Walgreens Settles “Falsely-Inflated” Drug Prices Lawsuit

Those of us in the health benefits field know Walgreens as one of the most expensive prescription drug retail outlets on the planet. Most of our clients have eliminated Walgreens from their network.

Fiduciary Liability Insurance

If your company offers health insurance benefits, then you most likely have a department of people that oversees the program. But did you know that if one of them makes a mistake your company could be held liable?

Conservative Momentum Builds to Lower Health Care Costs

The following content is sponsored by Conservatives for Lower Health Care Costs.

Recently, Big Pharma and Big Government have teamed up in a full-blown attack against free market solutions in the prescription drug market by focusing on Pharmacy Benefit Managers (PBMs) – which currently serve as the only real check on big pharmaceutical companies’ ability to set sky-high prices for prescription drugs.

This Reminds Me Of A West Texas School Superintendent

If you’ve learned a lot about leadership and making a movement, then let’s watch a movement happen, start to finish, in under 3 minutes, and dissect some lessons:

The KISS Method Of Selling

Skimming Money

PBM Representative Skims Off Drug Profits

Nearly half of every dollar spent by Medicare drug plans goes to private health insurers’ pharmacy benefit managers and wholesalers

By Wendell Potter

As members of Congress get back to business after the holidays, they seem to be poised to pass legislation that would address some of the abuses of pharmacy benefit managers (PBMs), the middlemen who extract so much money from the pharmaceutical supply chain.