November 2024 – Risk Managers

Why Would I Want To Work For Less?

“Yes, that’s right! The average rate of pay for risk managers is $106,000 so why would I work for less? My work product is not below average, it’s well above it.”

Harris Rosen

Harris was a business man who practiced manage care to a degree few others can imagine. He reminds us of Ruben Edelstein.

Official Admits To COVID Fairy Tale

“I probably shouldn’t be saying this out loud” Chief Confesses COVID Health Initiatives Were “COMPLETELY MADE UP”

Government Proposes Sending Billions In Drug Money To Denmark

Unreliable inside sources tell us executives at Novo Nordisk, Europe’s largest company and producer of ozempic, are excited beyond their wildest dreams after learning government printing presses in Washington may be sending plane loads of cash laden pallets their way.

“This will help offset the loss of the North Carolina State health plan and the University of Texas health plan“ said a jubilant C-suite executive.

HSA Company Accused Of Defrauding Consumers, Confiscating Funds

An HSA card

A Houston-based health services account provider is accused of stealing clients funds in a class action lawsuit filed in a Houston federal court.

Sit Down, Shut Up, and Accept It!

Hannah Tells Plan Sponsor How The Cow Ate The Cabbage

By Craig Gottwals

“Substitute ‘Anthem’ with any major insurer, and the story remains the same…. Anthem told Owens & Minor, a self-funded employer, that they wouldn’t release essential claims data because it might reveal ‘confidential’ provider arrangements …

Boon-Chapman Partners With Zakipoint Health

Zakipoint Health & Boon-Chapman Announce Strategic Partnership to Transform Healthcare Navigation & Member Engagement

Is COBRA Relevant Anymore?

Is COBRA relevant anymore? Not when you can get your own ACA mandated policy with comparable coverage for less cost.

How To Spot A Diabetic

Visual clues on how to spot a diabetic across the room.

ACA Re

Lucky Mary Loves Her Black Market ICHRA

Transferring high risk plan members by way of an insurance policy is nothing new. Self-funded health plans routinely purchase stop loss insurance for that purpose. Others have found another method made possible by the Affordable Care Act (ACA). We call it ACA Re, the best tax supported stop loss policy scheme ever designed by Congress.

Physicians & Surgeons Disability Plan

Physicians & Surgeons Disability Insurance Plan is designed to provide men and women working in the medical field with proper levels of income protection.

Ladder Life Insurance

Life insurance so good they will want you dead………….

Feeding Brokers At The Expense of Starving Ones

By Bill Rusteberg

In 1982, after nine years of corporate servitude, I left the inner sanctums of a large health insurance company and the comfort of receiving a corporate paycheck every two weeks whether I earned it or not.

Will the Affordable Care Act Survive A Trump Presidency?

President-elect Donald Trump has repeatedly vowed to repeal the Affordable Care Act (ACA), which ensures that 45 million Americans have access to health insurance. Will he finally deliver on his promises?

Non-Profit Hospital Pays CEO $5.6 Million Bonus

Children’s Hospital of Philadelphia delivered a record $7.7 million pay package to CEOMadeline Bell in 2021, as the coronavirus pandemic wreaked havoc in the health care industry, with deaths mounting and labor shortages putting nurses and other hospital staff under duress.

Carriers Compete For Broker Loyalty

Years ago when I was a commission driven insurance whore a TPA dropped by my office. “Bill, how many self-funded lives do you have on how many groups?” he asked. “Move 2,000 lives to us and I will not only pay you the same commissions you’re getting now but I will personally deliver a $250,000 check as our way of saying THANK YOU for the business!!”

Such is the world of health insurance brokerage…………………..

RFK Jr. Planning Major Changes To Medicare?

According to The Washington Post, Kennedy wants to overhaul Medicare billing codes.

Rx Reference Based Pricing

The high cost of prescription drugs is bankrupting health plans leaving plan sponsors little choice but to take action. The following describes two methods that will reduce drug spend by as much as 50%.

Here’s Proof PPO “A” Has The Best Discounts!

“The carriers are very good at playing this game and my belief is that most consultants don’t get it or pretend not to get it, thus doing a great dis-service to their client.” – PHO Sales Representative

Standing for Health Plan Excess Fee Cases – Do the J&J and Wells Fargo Health Plan Excess Fee Cases Meet the MetLife Decision’s High Bar for ERISA Defined-Benefit Plan Standing?

“They (J&J) want the right to file fiduciary-breach claims with no rules. It is a bold and brazen position. Surely Congress should amend the ERISA statute to protect against this type of litigation abuse.”

Chargemaster Duns Dead Person $181,102.03

Chargemaster, who no one ever pays, chases dead person for money. Takes grave robbery to a new level.

Will the hospital collect full chargemaster rates from the dead person? If not, will they write off the entire amount as charity care when their cost was a fraction of that?

CHARGE MASTER: Medical Bills Paradox

“We have to charge everybody more because we give away millions upon millions of free charity care!” says the hospital administrator. “Just look at what we charged off last year, over $1 billion! But we don’t mind because our policies are compassion based.“

“But almost no one ever pays chargemaster rates!” says the attorney. “Isn’t that true?“

“Objection!” screams the opposing side. “The plaintiff’s attorney is trying to sway the jury!’

Why Americans Don’t Fight Back

By Dutch Rojas

Despite rising premiums and dwindling options, most Americans remain passive.

The Physician in the Machine

Machine 1 to patient: “I’m referring you to Machine 2 for surgery. Here’s your password…………”

Big Pharma Launches Stop Kennedy Effort

This is going to be interesting. Vested interests are going to have to show their hand. Who will win?

8 Questions That Destroyed A PBM Relationship

A group with an annual pharmacy spend of $3.5 million decided to build their own formulary and asked their PBM if they could administer it. “Yes, of course” they said, “But our fees will go up.”

Patternicity in Health Care

“Sometimes it takes a prick to solve health care”

Our brain is a belief engine fueled by outside stimuli, recorded, sorted and placed in filing cabinets in our cranial warehouse to be retrieved at will when needed.

The Health Marketplace for All Act of 2024

The Health Marketplace for All Act of 2024 would allow any membership organization — which includes wholesale clubs (such as Costco), credit unions, and churches, among others — to offer an ERISA health plan to its members “across state lines—regardless of an employment relationship.”

Thatch Partners With Quickbooks To Bring ICHRA To Millions Of Small Businesses

This is more evidence of the explosive growth of ICHRA, compelling evidence tech-based vendors lead the future of health care financing and market distribution.

What is the Best Health Insurance Plan?

“For most people it is one that costs less. Group plans impose the costs on all because some minority want a richer plan or some bigger network. This is just another reason to move to an ICHRA.”

Emily

The following is based on a true story with an ending yet to occur. Suspense builds as the story unfolds towards its inevitable ending that’s sure to come. It is a struggle between right and wrong, greed and compassion, power and the powerless, David vs Goliath.

Healthcare Rebel Alliance: Q&A with Richard Hirsch, BillingNav

” I hate injustice and the abuse of power, and it angered me to see how hospitals and certain medical practitioners profit at the expense of people who do not have the ability to protect themselves from such abuse.”

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.

Marpai Expected To Reduce Expenses By +25%

“We continue to identify opportunities for further efficiency gains. A major project currently underway is expected to reduce TPA expenses by over 25% in Q1 2025……Marpai is gaining significant market traction and has a robust sales pipeline extending beyond Q1 2025.”

Never Under Estimate The Little Guy

Imagine Ruiz is an independent insurance consultant and Josua is a national well branded consulting firm with offices throughout the Fruited Plains. Which one do you think will get the business responding to a RFQ for consulting services?

Blue Cross Employee Wins $12.6 Million For Saying “NO!”

A woman fired by Blue Cross Blue Shield of Michigan for refusing to take a COVID-19 vaccination has been awarded more than $12 million in damages.

Millions At Risk Of Losing ACA Subsidies

“If Republicans end up winning the House, in addition to the Senate and White House, having a GOP sweep, I think the odds are less than 5% they get extended,” said Meekins, who was a senior HHS official in Trump’s first term. Even Democratic control of the House likely won’t save the subsidies, he added.

ACA’s Future

Will ACA Marketplace subsidies continue? (See #’s 1,3) Will brokers make less? (See # 5)

Why Should You Get Paid For A Loss You Didn’t Have?

Why would a stop loss carrier cover a loss when there was not one? Would it surprise you they routinely do that?

The Case Of The $0 Co-Pay Moral Hazard

Money Drives Behavior

People often do things with other people’s money (OPM) that they wouldn’t do with their own money. That’s an important consideration in insurance risk setting.

New Era Technology-Based Mega Brokerage Is The Future

In a previous posting we noted: “Health insurance brokers recognizing and adopting high tech brokerage aggregation will prosper. Hedge funds, always in search of lucrative opportunities, will join in, consolidating market distribution, creating a series of controlling regional monopolies of Gold Star Distributors. The few remaining legacy brokers left standing will be beholden, “Outside Producers.”

53% Of Americans May Be Eligible For Free or Discounted Health Care

“Many Americans, including 53% of employees from households earning less than $100,000 annually, are unaware of the existence of hospital financial assistance programs, which offer free or discounted care to eligible patients. BillAssist, available in multiple languages both in the app and with human support, helps users quickly determine eligibility and apply directly to the section 501(r) financial assistance policies at their healthcare system.”

“If they qualify, up to 100% of their out-of-pocket expenses may be written off by the hospital. If they don’t qualify, or receive only a partial discount, Emry negotiates directly with providers to settle at a reduced cost for the patient. Emry can also negotiate manageable payment plans for the remaining balance.”

Why Would Anyone Want To Be A Doctor These Days?

Sedated Hospital Owned Physician Enjoys On The Job Company Perks

CMS advertises that cutting physician payment for care increases access to care – laughable.

A Medicare Based True Story With A Happy Ending

Veterans Day 2024

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.

I knew little of my father’s participation in WW2 until after he died. Unlike veterans of today his generation didn’t talk much about it. Their quiet pride was enough, understood by all. The following recounts the Battle of Hatten in which my father was a participant. – Bill Rusteberg

Protection Money Is A Form Of Insurance

You Better Pay Up If You Want To Stay Healthy!

“Protection money, also known as “Pizzo” in Italian, was initially presented as a form of insurance.”

Why Dental Insurance Is A Terrible Investment

Dental insurance is proof insurance does not always make sense……………

Old Fashion Non-ACA Insurance Products To The Rescue

Attention Health Insurance Agents

Tired of selling health insurance? Yes, I know, it’s a really dumb question but humor me and read on.

Pasture, Rangeland, & Forage Insurance

DEADLINE TO APPLY FOR COVERAGE IS DECEMBER 1

Pasture, Rangeland and Forage (PRF) Insurance protects hay and livestock producers against loss of forage due to lack of rainfall on acres used for grazing or hay. The plan pays indemnities based on historical rainfall levels determined by a rainfall index.

Potential Employee Benefits Changes in Second Trump Term

“The new administration may still seek to make significant changes such as eliminating the ACA employer mandate penalties, streamlining ACA reporting, expanding HSAs, and codifying the ICHRA rules into statute.”

Healthcare Insurers Take Note: New Federal Whistleblower Program is Coming for You

November 6, 2024 David E. Leach Caroline J. Berdzik Scott R. Green

Key Takeaways:

New Corporate Whistleblower Awards Pilot Program incentivizes the reporting of corporate misconduct with the whistleblower possibly receiving upwards of $30 million
Healthcare insurance fraud schemes are one of the focuses of the program
The program ensures whistleblower confidentiality

Walgreens Agrees To $100,000,000.00 Settlement

Walgreens agrees to pay $100 mln to resolve lawsuit over generic drug pricing

Nov 4 (Reuters) – Walgreens (WBA.O), opens new tab has agreed to pay $100 million to settle a proposed class action lawsuit accusing it of fraudulently overcharging customers for a decade when they bought generic drugs through private insurance, Medicare or Medicaid.

DJT To Shake Up Health Care?

Donald Trump returns to the presidency with big ambitions to shake up health care

By Sarah Owermohle

Republican Donald Trump has won the presidency, marking a new era for federal health agencies and the industries they oversee. The president-elect campaigned on promises to shake up public health institutions, reshape federal health programs, and slash high costs across the system.

You Can’t Fight Against The Future

“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg

Employers Look to Cut Healthcare Program Costs and Boost Affordability

“Employers are adopting various strategies to ensure the affordability of their healthcare programs for both their companies and employees.

No Surprises Act Independent Dispute Resolution Outcomes for Emergency Services

“We analyzed public IDR data from 2023 for the most common disputed professional service: evaluation and management of a moderate to severe emergency medicine visit.

Term Life Like With – No A.R.T.

Currently, most all Term Products are designed to turn into Annual Renewable Term at the end of the guaranteed period.

This Makes No Sense

“Most political subdivisions have never bid out the dominant risk factor of their health plan that accounts for 90% of plan spend. Instead they have historically “gifted” public funds through intermediaries who have negotiated secretive contracts with health care providers they can’t see nor audit.” – Bill Rusteberg

November 6, 2024

Micky is feeling spunky today………..

Internal Emails Reveal Carrier’s Pricing Strategy

“UnitedHealth had already reduced payments from 450% of what Medicare pays — the benchmark that many insurers use as a starting point for their own figures — to 250%, and the company planned to drop it further to 150%, according to the email……..Such a cut would have put UnitedHealth below national averages: Employers and private insurers paid on average about 250% of Medicare’s reimbursement in 2022…..”

Defined Contribution Plans Are Becoming Popular Out Of Necessity

Get Ready for Health Insurance Premiums to Be ‘Highest in Decades’

Boon-Chapman Announces Appointment of Kari L. Niblack, Esq., as President

Austin, TX, November 5, 2024 — Boon-Chapman, a leading claims administration, cost containment and care navigation company, announces the appointment of Kari L. Niblack, Esq., as President. Niblack brings twenty-five years of expertise in leading and transforming multiple corporations in the self-insurance ecosystem and has a proven track record of driving hyper-growth and innovation.

‘Cash-For-Coverage’ Health Plans Could Win The Elections, Exec Says

Hallelujah! A Bi-Partisan Health Plan Emerges From The Chaos Of A Broken System

The head of an ICHRA administrator explains why the plans may emerge with bipartisan support.

Independent Pharmacies Sue GoodRx Over Price-Checking Strategy

“The usual PBM strategy cuts an independent pharmacy’s share of the prescription revenue to just 3 cents per pill dispensed, and the GoodRx relationships with the PBMs cut the independent pharmacies’ share of the revenue even more,”

HealthCare.gov Open Enrollment Starts Amid Rising Interest in ICHRAs

Interest in ICHRAs has surged, with a 100% increase in search activity compared to last year.

Providers’ Winning Streak In No Surprises Act QPA Litigation Ends As Appeals Court Overturns A Prior Ruling

Plan Sponsor Reacts

The TMA is 4-0 in contesting aspects of the No Surprises Act. At the appellate level, the TMA is 1-1

“The decision means insurers can calculate qualifying payment amounts using factors that provider advocates say should not enter into the equation.”

Is Snejina Zacharia The Biggest Auto Insurance Broker On The Planet?

SOURCE: MIT Graduate Saw An Opportunity & Seized It.

When a minor accident sent Snejina Zacharia’s car insurance premium skyrocketing, she went in search of a better, cheaper policy. She discovered insurance shopping is too often exasperating, and inefficient, filled with hours of phone calls, and an inbox overflowing with spam.

Mary Talley Bowden MD

At BreatheMD, we prioritize our patients over politics.

40 Years Of Managed Care – So Much For Your Promises!

So much for your promises. You’ve given me nothing but shattered dreams……………….

A New Type of Health Plan You Never Heard Of

MEDSAVE MANAGEMENT LLC is pleased to announce a new health plan option members may choose when seeking medical care. This program is designed for self-funded health plans interested in achieving additional plan savings while improving benefits at the same time without disrupting existing relationships.

Welcome to Plan Stewards

Empowering Health Plans and Their Members

At Plan Stewards, we’re more than just a Third-Party Administrator. We’re your trusted partner in navigating the complex world of healthcare benefits. With over 150 years of collective experience, our team is dedicated to providing cutting-edge cost containment solutions, groundbreaking direct contracts, and adaptable plan designs.

Miracle OTC Drug Hits The Market

Half of America To Benefit.

Big Pharma reports “Initial sales will be limited to Blue States. Red States are immune.“

California, New York, Oregon, Washington, and Illinois state officials have promised to stop Trumpenol from hitting retail shelves citing “adverse side effects.”

Attention Brokers: One Stop Carrier Appointment Is Here

ATTENTION BROKERS: Core Benefits Group will assist you in getting contracted with any carrier active in your area. Go here Health Contract Request.