May 2024 – Risk Managers

Amazing Things You Learn When They Forget You’re In The Room

As I left the serving line at Lubys and entered the packed dining room looking for a vacant place to sit I heard “Hey Billy, Come join us over here. We have an extra seat for you.”

Government Controlled Risk Pool Guarantees Health Insurance Coverage For All Americans

Few Texans know that the government has established a guaranteed risk pool currently covering more than 3,000,000 Texans. A mounting number of plan sponsors are taking advantage of that.

Katy ISD Sponsors Health Care Summit

Chain of Custody

The Chain of Custody game show is alive and well despite the new age of transparency sweeping throughout the government controlled American health insurance industry.

Income Based Health Care

Government to empower poor people needing a kidney transplant to cut in line……….

Iron Lung Keeps Managed Care Alive

The paralyzing and debilitating effect of high octane risk aversion is evident among 99% of employers who sponsor group health insurance plans.

Did Aetna Destroy The TSHBP?

The Reference Based Pricing plan option is working great. The Aetna plan option isn’t. Collectively it’s a disaster…………….Is Aetna and Europe’s largest company to blame?

The suit argues that Aetna “took money from Grainger under the guise of claims administration, transferred the money to accounts under Aetna’s control, paid a fraction of that money to health care providers to settle the claims, and kept the difference.”

Daffodil – Powerful Claim Repricing Engine

Daffodil is a powerful pricing and explanation engine that takes claims in multiple formats and offers you complete visibility & control of the pricing process.

A New Horizon in Health Care: How ICHRAs Could Transform American Health Insurance

“Individual Coverage Health Reimbursement Arrangements present a compelling blueprint for a more inclusive, flexible, and sustainable health coverage model. By embracing this innovative approach, we can move closer to the ideal of universal health care coverage, tailored to the needs and preferences of every American.“

The Great Sphinx of Austin

A Novella by Don Pedro

The explosion was not unexpected but the aftermath wasn’t……..

Memorial Day 2024 – Remembering The Jews of Dachau

A letter to his children by Col. E. Rusteberg dated 28 September, 1989

There it was, on his cap, the “Death Head” of the SS Toten Kopf, the dreaded and most feared of Hitler’s ruthless legions.

More Lloyds of London History By Miller

By Paul Miller

Mr. Carleton Fowell Tufnell, was a member of Lloyd’s who joined the market in 1889. He was also a talented cricketer who played for Kent, for whom he set a world record after bowling 20 maidens in one match.

Introducing The NAVZERO Cash Pay Health Plan

Introducing the NAVZERO Cash Pay Health Plan (by Navigation Health) which leverages the power of cash payments to provide the richest benefit plan available, at significantly lower costs (10% to 30% savings), without noise and disruption.

Customer Service

Have you ever called your insurance company about a claim? Or, if a broker, have you ever responded to an advertisement for a neat, new insurance brokerage product?

Is The TSHBP Risk Pool Bankrupt?

The ultimate question will be is there be enough money to honor all eligible claims through August 2024? If not, where is the money going to come from?

TSHBP Risk Pool Goes Bye Bye

The TSHBP risk pool has been unsuccessful in turning around significant underwriting loses despite back-to-back annual rate increases and a cash call to the tune of millions of dollars.

TSHBP officials are “Throwing in the towel” while attempting to replace commissions at the same time by offering commercial health coverage on a stand-alone basis to each TSHBP member district.

Centivo News

We are pleased to share some significant news that will further enhance our commitment to providing affordable, high-quality healthcare solutions for your clients. Centivo has officially acquired Eden Health, an innovative employer-centered virtual-first medical provider.

American Healthcare Finance Is Bullshit

Billed Charges = $2,341,142.50. PPO allowed amount = $1.872,530.66. Plan negotiated down to $531,818.53……………Proof that billed charges are bullshit and PPO discounts are bullshit too. The American healthcare finance system is bullshit controlled by bullies……………....

Does this possibly prove there is no such thing as a $1 Million claim?

Imagine That!

Imagine an underwriting process that’s faster than a speeding bullet and more powerful than a locomotive.

Marshall Allen: A Relentless Voice for the Little Guy

By Dave Chase – May 19, 2024

On Sunday, May 19, we lost an extraordinary man, Marshall Allen, a dedicated journalist and former member of the clergy, whose unwavering commitment to investigative journalism has left an indelible mark on the healthcare industry. His tireless work exposed the deep-seated issues within the healthcare system, shedding light on price gouging, sloppy billing, fraud, insurance denials, and unnecessary treatments that preyed on vulnerable Americans.

How Texas School Districts Can Get Out Of The Health Insurance Business

Seriously Meme

Dear Superintendent,

As a superintendent one of your biggest headaches is dealing with health insurance every year. Your budget depends on it.

Aldeen’s Sunday Morning Bathroom Read – The OMG Edition

By Doug Aldeen

Rand recently published its report ( Rand 5.0) that suggests hospitals, on average, markup their prices for commercial carriers at 254% of Medicare. The American Hospital Association in its press release, in typical fashion, takes organizations like Multiplan to task and asserts that Multiplan and its commercial carrier clients are somehow to blame.

Murder Weapon Identified

“The doctor who did the autopsy said that when he tried to remove the heart, it was soft and had disintegrated…….” Physician says it’s ‘essentially murder.”

Mayday!

The month of May brings disturbing news to Mother. “Mom, I’ve spent more than my allowance allows. I owe the bookie at school and he wants his money now! I need another $637,500!” says the soon to be orphaned school superintendent.

Miami ISD Considers Bolting From TSHBP In Favor of Curative Health

“We have received information from TSHBP that the yearly claims for the program were over budget and therefore a surcharge of $150 per employee for 10 months will be assessed. Due to this, we are pursuing other health care options through a fully funded insurance program for our employees. Currently, the best option is the Curative plan.”

Plumbers, Electricians, and Primary Care Physicians

What do plumbers, electricians and primary care physicians have in common?

Cris Slaps School District CFO

By Cris Deacon

I can tell you exactly what I’m saying at this moment during a panel at the Employers’ Forum of Indiana Annual Conference yesterday….

The Disco Discount Game & The Power of An EOB

A 50% discount off double the price doesn’t sound like much of a deal. A 60% discount off triple the price sounds even worse. How about an 80% discount off quadrupled the price?

Leveraging Risk Transfer Through The Federal Risk Adjustment / High Risk Pool Program

Hot Potato Risk Transfer Method

Self-funded health plans have traditionally ceded large and unexpected losses through insurance policies naming the plan sponsor as the insured. Under these policies plan sponsors are reimbursed for losses. Many have now discovered they can duplicate this risk transfer strategy through a more efficient and economical method by naming the plan member as the insured.

Government Mandates Reference Based Pricing For Indians

“Tonto That Hospital Charged Me 4 Times More Than They Charged You!”

Dear Tonto,

“I am pleased to announce that on June 4 the Indian Health Service (IHS) and the Centers for Medicare & Medicaid Services (CMS) published the much anticipated final rule implementing “Medicare-like” payment rates. The “Medicare-like” payinent rate will constitute payment in fill1 to Medicare-participating hospitals that deliver services to American Indians and Alaska Natives…..” SOURCE: Tribal Leader Letter

2024 ACA Broker Commissions

Ever wonder what health insurance brokers earn in commissions selling individual health insurance policies these days? Would it surprise you that with bonus commissions a broker for one of the carriers can earn up to a maximum of $500,000 in a year?

Iron Sky Advisors

Podcast Referred By Brent Evans

In today’s episode, Dr. Ben interviews Jeff Borglin with Iron Sky Advisors

Jeff and his team help corporate businesses find the real data of what they are spending on insurance. This is not always an easy task. They also discuss how the insurance model got to where it is, and why it keeps rising year over year. Is there a solution?

The Real Reason Why Walmart Failed At Delivering Cost Effective Health Care

“They’re skinnin’ us alive.”

Walmart’s failed attempt in delivering cash paid health care proved “that the cash model wasn’t going to work……”

Ex Hospital Workers Advise Not Going to White Rock Medical Center

By Jesse Oberoi – Freelance Writer

May 12, 2024

Former employees who were recently laid off from the White Rock Medical Center claim the hospital’s severe financial challenges should raise questions about its ability to service patients.

School District Alert: Beware of Health Insurance Cooperatives

Although the following article is 3 years old we may be seeing a similar debacle unfolding before our very own eyes in Texas in 2024……………

“Dozens of school districts left scrambling to pay $11.6 million in debts, a financial shipwreck that raises concerns about such ventures, which are virtually unregulated……“

Why Do Insurers & Hospitals Fight Over Prices?

Baylor Scott & White Health to Terminate Blue Cross Blue Shield Agreements in July

Why should health insurance companies negotiate lower prices with hospitals when, thanks to the federal government mandate known as the Minimum Loss Ratio, both get paid more through higher prices? A sign of a good business deal is when both sides walk away from the table happy.

Guaranteed Protection From Balance Billing

WellRithms Publishes Groundbreaking White Paper: The Wait is Over – Guaranteed Protection from Balance Billing

MedWatch and AstroDoc Team Up for Virtual Primary Care

Source: MedWatch, 5/8/2024

Lake Mary, FL – MedWatch, a leading provider of concierge member advocacy and medical cost containment solutions, recently partnered with AstroDoc, a pioneer in Concierge Primary Care, to host an exclusive webinar exploring AstroDoc’s VIP-Level Virtual Primary Care service.

Group Whole Life Insurance

PRODUCT HIGHLIGHTS
• Permanent life insurance to age 120
• A level premium that is guaranteed to never increase
• Guaranteed death benefit, generally free from federal income tax1
• Guaranteed access to Living Care benefit
• Guaranteed Cash Value
• Portable at the same rate and benefit amount

Magic Pill

Free medicines delivered fast for $15 per month.

Free Medical Care Coming To All Houston ISD Campuses Next School Year

Article Referred By Lori Ramos

Houston ISD to offer free telehealth services to all campuses after expanding partnership with national provider

The program is funded through a combination of insurance and fees. Hazel Health will bill for services on behalf of students with health insurance through their parents. A portion of Hazel Health’s platform fees are used to offset any out-of-pocket expenses not covered by insurance. Students with no insurance receive free care too. Hazel Health verifies uninsured status after sign-up.

Who Would Have Ever Thought!

Sharks Are Circling TSHBP For The Kill

A run on the bank appears to be in full swing. The sharks smell blood. Will TSHBP survive?

New Wellness Program

Picture credit to Marshall Allen

New wellness program takes plan sponsors by storm, saving millions in insurance premiums.

5 Reasons by BUCAs Will Suddenly Fail

By Taylor Davis

Some of my memories of Blockbuster (disrupted by Netflix) and taxis (disrupted by Uber) are very similar. Very paternalistic, protectionist, and offering very little value themselves. BUCAs feel the same way.

The Momentum Towards A Single Payer System Gains Steam

“No one in America should face financial ruin because of the outrageous cost of an unexpected medical emergency or a hospital stay,” Sanders said. “The time has come to cancel all medical debt and guarantee health care to all as a human right, not a privilege.”

Mexican Dogs Get Better Deals

A friend runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”

More Lloyds of London History By Miller

By Paul Miller

When the star of Singing in the Rain, Debbie Reynolds, broke up with Eddie Fisher in 1959, her home insurance rates went up on the theory that: “there is more safety when there’s a man about the house.”

Five Tips To Implement Direct Primary Care Successfully

By Chris Barakat – First Primary Care

5 Tips to properly implement DPC in your health plan (from experience not ChatGPT)

Ivermectin – No Prescription Needed

For an affordable $10.99 copay you can get a lifetime supply of Ivermectin at feed & seed store near you. No prescription needed. So stop horsing around, be prepared and place a tube of Ivermectin in your medicine cabinet kit today!

An Open Letter To The Amarillo Independent School District

This Open Letter to the Amarillo Independent School District has far more implications than just a story about a West Texas public school district’s failed efforts to reign in rising health insurance costs. It’s a story about a malaise affecting elected officials under status quo influence where nothing changes.

Josh Butler, a local Amarillo taxpayer and nationally recognized health insurance expert writes an excellent piece that, quite frankly, is one of the best we’ve seen. His open letter is representative of the continuing failure of elected officials everywhere to control health care costs when it’s been proven by others they can.

Hat Tip To Mitigate Partners

Happy Friday Mr. Schuessler,

I hope this email finds you well enjoying this amazingly beautiful springtime weather we are having. I wanted to take a moment to reach out via email, introduce myself and see if I could schedule a call with you to discuss Mitigate Partners services.

Confuse & Delay Is Always To The Advantage of The Incumbent

A risk pool of more than 20,000 member lives composed of an aggregation of Texas public school districts is looking for a home. The pool has suffered significant underwriting losses necessitating a mid-year cash call to the tune of millions of dollars to pay claims and cover expenses. A run on the bank appears imminent.

Working Americans Struggling To Afford Health Insurance Rejoice!

Adding +100,000 Young People Will Surely Help Lower Rates!

More than 100,000 young immigrants protected by the Deferred Action for Childhood Arrivals program will soon become eligible to receive federal health care coverage for the first time since DACA was implemented over a decade ago.

The Persecution of Dr. Mary Bowden

Houston doctor Mary Bowden made some powerful enemies during the COVID-19 pandemic.

Virtual Care Becoming A Highly Competitive Business Model

Modern Age Doctor Visit

We are seeing more companies entering the virtual care market supported by deep pocketed investors sensing lucrative opportunities in an emerging market.

This virtual care program connects users to a doctor in less than 60 seconds, 24/7/365. Enhances efficiency supporting early diagnosis and treatment while improving health outcomes and reducing healthcare costs.

Amputee Takes Up Running After Surgery

Death Panels Abroad

DEATH PANELS ABROAD: Cigna Whistleblower Reveals How Employees in the Philippines Play a Key Roll in Denying Care for American Beneficiaries

TRS ActiveCare Releases 2024-2025 Renewal

Poof! With a wave of a magical managed care wand TRS officials claw back teacher raises…….

‘Houston Resident Charged Surprise $400 ‘Facility Fee’ After Doctor Visit

HOUSTON – Unexpected, unexplained fees are driving up the cost of doctor visits for families across Houston. We are talking hundreds of dollars in charges above your co-pay. They’re called “facility fees,” and patients are told days or weeks after their appointments they have to pay up.

More Lloyds of London History by Miller

By Paul Miller

When war broke out, Lieutenant Gerald Deakin left his role at Lloyd’s as a marine underwriting assistant and joined the Rifle Brigade.

Did You Lose or Win?

“In risk transfer one must always keep in mind that, by definition, there will be a loser for every winner” – Carlton Harker

The Bubonic Plague of Risk Pools

By Jody Bright

In the world of risk pools such as Multiple Employer Trusts (METs), Multiple Employer Welfare Arrangements (MEWAs), Interlocal Governmental Agreements, and other risk cooperatives and even Captive Insurance Companies size is not the real magic. Yes, there are inherent benefits to size and creating opportunities to bring home greater savings are among these but without a differentiating risk strategy the risks could outweigh the advantages.