May 2024 – Risk Managers

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

HOUSTON – Houston ISD announced it will be expanding its partnership with a national healthcare provider to ensure students have free access to virtual doctor’s visits.

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.

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