
Drugs like Wegovy may trim your waistline but not medical costs, according to an analysis of U.S. health insurance claims shared with Reuters.
Continue reading Weight-Loss Drugs Didn’t Curb Health Costs Within Two YearsDrugs like Wegovy may trim your waistline but not medical costs, according to an analysis of U.S. health insurance claims shared with Reuters.
Continue reading Weight-Loss Drugs Didn’t Curb Health Costs Within Two YearsOur mission at SmithRx is to secure the lowest cost prescription drugs, upholding transparency and integrity while prioritizing the best interests of both employers and patients.
Continue reading SmithRx is Transforming Pharmacy BenefitsBy Bill Rusteberg
The American health care delivery system has reached a boiling point. The average working American can no longer afford health insurance and those who can often find they can’t afford to use it.
Continue reading The American Health Care Crisis – Is It Time For Civil Disobedience?Part Two of a continuing series pointing out reasons why employers want out of the health insurance business. Part One and Part Two bring the total number of reasons employers want out to 14 and counting…………….
Continue reading PART TWO: More Reasons Employers Want Out Of The Health Insurance BusinessReady to quit the billing game and fall in love with practicing medicine again? Join the First Primary Care team of medical professionals, from MDs and DOs to MAs and FNPs, that change the way doctors and patients experience healthcare. – Geetinder Goyal, MD – CEO, First Primary Care
Continue reading First Primary Care DPC Is Hiring Full-Time PhysiciansWith the passage of the Affordable Care Act (ACA) effectively turning private health insurance plans into a de facto government utility managed by bureaucrats in far away places, plan sponsors have become increasingly subjected to freedom robbing government mandates and punishing sanctions.
Continue reading Seven More Reasons Why Employers Want Out Of the Health Insurance Business“Third-party vendor quietly held insurance rebates that accrued to $8 million in an off-the-books account…..”
Continue reading Insurance Rebates In Off-The-Books Account Raises Eyebrows
If you have questions about attending contact Jamaal Lewis at jalewis@alm.com. If you have questions about sponsoring please contact Craig Williams at crwilliams@alm.com.
McGowan Program Administrators (MPA) is America’s leading writer of innovative insurance programs. MPA is a Managing General Underwriter and Program Manager. MPA designs, administers and markets highly-specialized programs of insurance. These programs are available exclusively through MPA. They are offered on “A” Rated, Admitted Paper and are available in all 50 states.
Continue reading America’s Leading Writer of Innovative Insurance ProgramsThe state is already making hundreds of millions of dollars from enrollment fees on the site in partnership with brokers.
Continue reading Georgia Earns Millions Off ACA WebsiteSean R. Gallagher, Jason T. Weber and Ross T. Weimer
October 25, 2024
This past week, the FTC appealed a Texas federal court’s August ruling that blocked nationwide enforcement of the non-compete ban. The non-compete ban will remain blocked during the pendency of the appeal process. However, the outcome of the appeal will determine: (1) whether the non-compete ban remains blocked; and (2) the future scope of the FTC’s regulatory authority. There are three court challenges to the non-compete ban. The status of those challenges (including appeals) is detailed below:
Continue reading Stay Tuned… FTC Seeks to Breathe Life Back Into Non-Compete BanSOURCE: Efficiency Commission Would ‘Unburden’ Us from a Federal Healthcare Nightmare
“The American healthcare system is increasingly falling behind as critical funds are funneled into bureaucratic red tape rather than innovation. Administrative costs have exploded, diverting resources that could otherwise fuel groundbreaking medical advancements. Instead of prioritizing cutting-edge research and life-saving treatments, far too much healthcare spending is consumed by paperwork, compliance protocols, and outdated systems. This misallocation of funds stifles research, patient care, and global competitiveness.”
Continue reading Cutting Waste In Government Controlled Healthcare“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
Voluntary employee benefits is a huge and lucrative market for insurance agents. There are tons of competition in that space. To be successful you must be different and better.
Continue reading Worksite Marketing – This Is What SellsA Fairy Tale By Molly Mulebriar
Once Upon A Time a health insurance agent presented an ICHRA proposal to the wicked witch of HR, a bald headed spinster known as Ms. No Never…………..
Continue reading Baskin-Robbins Disproves HR Myth But The Salesman Is DungeonedEvery day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.
Continue reading Here’s The Company Who Decides Whether To Pay For Health Care for 100,000,000 HumansHave the Texas Municipal League (TML), Texas Association of Counties (TAC) and the TRS ActiveCare (TRSAC) health plans become obsolete in today’s market?
Continue reading Are TML, TAC, and TRSAC Health Plans Obsolete?Melody Learns The Truth After Getting What She Wished For
Ana Delian, an intensive care nurse, earns $18 a month . “They pay you little and you work loads.”
Continue reading Government Run Health Care Doesn’t Pay SquatSend Lawyers, Guns and Money Part III
The American Medical Association recently oined the fray and sued Multiplan earlier this week in federal district court in Chicago. At issue is MultiPlan’s business model. Instead of determining their own out-of-network rates, insurers can outsource that function to MultiPlan, which promises to save them money on those claims. In many cases, MultiPlan uses an algorithm-based tool to recommend a payment level — and receives a portion of the difference between the recommendation and the original out-of-network bill, giving the company a financial incentive to recommend lower rates. The majority of U.S. insurers, including the 15 largest in the country, use MultiPlan to determine out-of-network payments.
Continue reading Aldeen’s Sunday Morning Bathroom ReadIndependent Dispute Resolution (IDR) Decisions Appear to Greatly Increase Claim Costs for Self-funded Health Plans and Other Payors
Continue reading Hospitals Hit The Motherload With NSA IDRBlue Cross and Blue Shield of Texas to remove Houston’s MD Anderson Cancer Center from Medicare, Medicaid networks
HOUSTON – Blue Cross and Blue Shield of Texas announced it has made the decision to remove MD Anderson Cancer Center in Houston from its Medicare Advantage PPO, Blue Cross Medicare Advantage HMO, and Medicaid networks effective Nov. 1, 2024.
Continue reading BCBS To Remove Houston’s MD Anderson From Medicare, Medicaid NetworksSeptember 25, 2024
Bell Nunnally Represents Primary Care Network Frontier Direct Care in $10M Acquisition of Health Plan Provider Asserta Health
SOURCE: Bell Nunnally & Martin LLP
Bell Nunnally, led by Partner Ray A. Balestri and Senior Associate Joshua T. Smith, represented Harlingen, Texas-based primary care provider network Frontier Network, Inc. (d/b/a Frontier Direct Care) in its acquisition of Salt Lake City, Utah-based Asserta Health Inc. Asserta offers employers access to a cash-driven health plan, enabling self-insured and level funded employers to deliver health care benefits to their plan members. The deal, executed through stock-for-stock exchange, had an estimated value of $10 million.
Continue reading Frontier Acquistion of Asserta Health Valued At $10,000,0002025 Seattle Hotel Employees Ordinance Expenditure Rates
SOURCE: 2025 Seattle Hotel Employees Ordinance Expenditure Rates
The Seattle Office of Labor Standards (“OLS”) announced the adjusted rates for 2025 health care expenditures required by the Improving Access to Medical Care Hotel Employees Ordinance, Seattle Municipal Code (SMC) 14.28.
Continue reading Seattle Hotel Owners Must Provide Employees With Families $20,232 Per Year In Health Care Benefit AccessMost Texas school districts are unaware of a new health plan option that’s quickly fulfilling market demand across the country. “Why haven’t we heard about this? is a common question we get from district officials. “What is it and how does it work?” they ask. Dr. Eric Bricker explains it best in this short informative video.
Continue reading A Common Sense Alternative To TRS ActiveCare For Region One School Districts?NEW YORK–(BUSINESS WIRE)–Oscar Health, Inc. (“Oscar”) (NYSE: OSCR), a leading healthcare technology company, today announced it will bring the Oscar experience to more individuals, families, and businesses through the ACA marketplace in 2025. Oscar is introducing affordable health insurance products that empower people to pursue a healthy life on their terms with:
Most fully-insured group health plans have a claim pooling point which acts as a stop loss insurance policy against high unexpected individual claims. The scheme is intended to mitigate rate increases by transferring specific risks.
Continue reading How Much Are You Paying For Your Pooling Point?Hospital price increases since 2000 outpaced inflation by more than double, Baker Institute report says
SOURCE: Rice University
Hospital service prices surged more than 220% between 2000 and 2022, according to a report from Rice University’s Baker Institute for Public Policy.
Continue reading Hospital Prices Have Increased 220% Since 2000What Do Car Dealerships & PPO Networks Have In Common?
Would you pay $25 pepm to access a PPO network to get a 50% discount off a 600-1000% markup?
Continue reading PPO DiscountsTRS ActiveCare trustees were given updated financials at their September 2024 quarterly board meeting with financial projections through 2027.
Continue reading TRS ActiveCare Financial Update Assumes 9% Increase In 2025“This Notice expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) under section 223(c)(2)(C) of the Internal Revenue Code (Code) without a deductible, or with a deductible below the applicable minimum deductible for the HDHP….”
Continue reading Is Dexcon Covered Under The ACA Preventive Care Mandate?“The only way that we would be able to get into any school district was to be able to directly have a relationship with the decisionmakers — the school board, the trustees. We wouldn’t waste time on people where we couldn’t make money. We would contribute to the opponent of those (board members) who did not vote for us.” – Criminal Turned FBI Informant
Continue reading Anatomy of Public Entity Insurance CorruptionBy Dutch Rojas
30% of physicians will retire in the next ten years.
Continue reading The State of US HealthcareThe Largest ACA Quoting & Enrollment Platform On The Planet
How would you like to have 45,000 agents working for you while you’re at home sipping coffee in your pajamas? Two young techy types have done just that! That’s “Working Smart.”
Continue reading 45,000 Agents & 4,800 Agencies Can’t Be WrongAnother powerful 27 minute video featuring Ron Piana. You don’t want to miss this one! He explains a method that effectively causes “very rapid cell death” that those within “The Fortress of Dogma” refuse to acknowledge.
Continue reading Curing Cancer (Affordability)Ex-FDA food expert reveals why Kellogg’s Froot Loops is worst cereal in US- amid calls for cancer chemical ban…………
Continue reading Fruit LoopsShould fee-based insurance consultants be paid the same as commission – insurance agents and brokers for producing the similar results?
Continue reading What’s Good For The Goose Is Good For The GanderThe MotivHealth story began almost 20 years ago when two friends were having a conversation about the rising cost of health insurance premiums. The conversation went something like this:
Continue reading “Nobody Spends Somebody Else’s Money As Wisely As He Spends His Own”Hello Down There….Trouble Breathing?
Two unelected government bureaucrats, Elizabeth Choi and Amy S. Wei of the Office of Associate Chief Counsel, have issued their ruling that provides a safe harbor for condoms.
Continue reading Rejoice! Government Promulgates Tax Free Condom RulingZANTAC is a medication used to decrease stomach acid production. It was commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. It can be given by mouth, injection into a muscle, or injection into a vein.
Continue reading $2.2 Billion Settlement Causes Zantac HeartburnIf we haven’t convinced you yet, let’s do a little side-by-side comparison of group plans and ICHRAs
Continue reading ICHRA vs Group Plans“The Departments of Treasury, Health and Human Services, and Labor have imposed new nationwide duration limits on short-term limited duration insurance (STLDI) plans. The limits began Sept. 1.”
Continue reading There’s More Than One Way To Skin A Cat!“If you want the business I need $5 per script” wrote the consultant for a +7,000 life Texas school district.
Continue reading Amazing $500,000 DeceptionSOURCE: UPI.com
Results from a very small study suggest that a combination of the diabetes drug Ozempic and an innovative new intestinal procedure could help erase the need for insulin in folks with Type 2 diabetes.
Continue reading Endoscopic Re-Cellularization Via Electroporation TherapyCigar loving attorney wins the annual Criminal Lawyer Award Contest (Yes, this is insurance related in case you’re wondering)
Continue reading And The Winner Is……….By Stacy Edgar
Happy First Day of Medicare Open Enrollment! It’s that time of year when our TV screens will feature this guy here.
Continue reading ICHRA & MedicareSOURCE: HFMA
A court edict earlier this year essentially would allow insurers to ignore arbitration decisions on out-of-network payments.
Continue reading Providers Seek To Reverse Court’s No Surprises Act Ruling On EnforceabilityMy Moma always said “Lawyers Have More Fun!”
SOURCE: Whatley Kallas
October 14, 2024
FOR IMMEDIATE RELEASE: October 14, 2024
BIRMINGHAM, AL – Today a monumental settlement was announced by Whatley Kallas, LLP, Co-Lead Counsel, in a long-running antitrust lawsuit filed on behalf of healthcare providers across the nation. The settlement with all the Blue Cross and Blue Shield entities in the country, as well as the Blue Cross and Blue Shield Association, provides billions of dollars for healthcare providers and is the largest antitrust settlement in the history of the United States healthcare industry. The settlement includes a $2.8 billion cash payment into a settlement fund, as well as investments by the Blues of hundreds of millions of dollars in system improvements for the benefit of providers. Provider Plaintiffs have asked the court to preliminarily approve the settlement, which would resolve their claims that the Blues violated the antitrust laws by, among other things, agreeing to allocate markets through the use of exclusive service areas and to fix the prices paid to providers through the BlueCard Program.
Continue reading MONUMENTAL SETTLEMENT ANNOUNCED IN PROVIDER BLUE CROSS BLUE SHIELD ANTITRUST CASEWe receive hundreds of emails a week from Insurance Companies, General Agents, Wholesale Brokerages pushing out their products and services.
Continue reading Insurance Solicitations Keep Us Market InformedSOURCE: Pre-Tax Versus Post-Tax
Let’s say you decide to give your employees an extra $200 each month (totaling $2,400 per year) to help with their health insurance premiums. The amount they can actually use is a lot less, thanks to those pesky payroll and income taxes. How much so?
Continue reading What’s The Difference Between Pre-Tax and Post-Tax?The day and age when employees are given Daddy’s Credit Card to go anywhere, anytime, for anything related to company paid health care may be coming to an end sooner than you think.
Continue reading Expect Employers To Get More Picky About Who You See For CareICHRA BLITZKREIG DEFEATS LEGACY GROUP HEALTH PLANS
“Entering their fifth year as a tax-advantaged solution for employer-sponsored insurance, Individual Coverage Health Reimbursement Arrangements (ICHRAs) had nearly 30% year over-year growth from 2023 to 2024, with Applicable Large Employers (ALEs) as the fastest growing cohort.”
Continue reading Large Employer Adoption of ICHRA Is Growing ExponentiallyReminder: Your Fiduciary Duties as a Plan Administrator of a Group Health Plan Include Reviewing Fee Disclosures
Continue reading One More Reason Employers Want Out of The Health Insurance BusinessBy Preston Alexander
It costs $25,572 to be allowed to pay for healthcare
Continue reading The American Healthcare Cover ChargeTeva is the largest generic drug manufacturer in the world. Last year, the company took in $15.8 billion in revenue globally.
Continue reading Israeli Company Is Largest Generic Drug Manufacturer In The WorldThose who learn a second language may have more efficient brains, a new study published in Nature Communications Biology found.
Continue reading Bilinguals Have More Efficient BrainsHoly Smoke! Another ICHRA Administrator Shows Up In The Market! We are beginning to lose count……………..
“Getting healthcare for your business is a pain. Talking to brokers, picking a plan and benefits, managing issues that arise, open enrollment — it’s a lot of work. And as your team grows, it only gets harder and more time-consuming.”
Continue reading ThatchICHRA has spawned a lot of interest on Linkedin these days, a running commentary between proponents and non-believers. Who’s right?
Continue reading ICHRA: Believers VS Non-BelieversAn interview and portrait of Ron Piana, a science writer who worked in the oncology industry.
This is a fascinating 44 minute video. We have time stamped at about 29 minutes but you should rewind and watch the entire video if you have time.
Continue reading Greed and the Pharmaceutical Industry
GLP-1 Coverage, Family Annual Cost Exceeds $25,000, More
Source: Survey Report
This is the 26th annual Employer Health Benefits Survey. As in years past, the survey examines trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices.
Continue reading KFF Releases 2024 Employer Health Benefits SurveyAM Best affirms PA-2 rating for Excess Re, outlook stable
Source: Reinsurance Business,
AM Best has affirmed the PA-2 (Excellent) Performance Assessment of Excess Reinsurance Underwriters Inc. (Excess Re), based in Woodbury, N.J. The outlook for the assessment remains stable.
Continue reading Excess Re’s Underwriting Performance Earns “Excellent” RatingBy Doug Aldeen
Sample road map of plan sponsor and stop loss ERISA fiduciary considerations PY 2025:
Continue reading Aldeen’s Sunday Morning Bathroom ReadWe are not sure what this is. Vendor websites tend to be purposely vague on details to whet curiosity, entice inquiry.
Continue reading Mysterious Yet Intriguing Health Benefit Strategy Spikes Boundless CuriosityCongress should shift the tax advantage from employers to employees to empower patients.
“The system has ballooned into an inefficient approach that inflates costs and reduces consumer choice. If the tax advantage were transferred from employer to employee, this would expand the usefulness of these funds to pay for medical expenses.”
Continue reading The Trap of Employer-Sponsored Health Insurance: Time to Empower PatientsLarge Employers can use one of three “affordability safe harbors” to show their coverage is “affordable”:
Continue reading Employers Should Confirm Affordability for 2024 & 2025 To Avoid Government PunishmentKFF 2023 Employer Health Benefits Survey
“The average annual premium for employer-sponsored health insurance in 2023 is $8,435 for single coverage and $23,968 for family coverage.”
Continue reading How Do Your Health Insurance Rates Compare To National Averages?Health Care Is A Profit Driven Business
We are seeing more plans like this every day. But is it worth what it costs?
Continue reading $5,000 Dental PlanThe federal government risk adjustment program is a risk sharing cooperative in the individual health insurance market place designed to transfer funds from profitable insurance companies to less profitable ones.
Continue reading Government Proposes 2026 Risk Adjustment Modification