Press 1 For English, Press 5 For Benefits – You Are Now #37 In The Queue

Can you answer a question about my health plan benefits?”

Employees ask that question every day.  And to get their answer, they will …

– Call the number on the back of their insurance card to hear “Press 1 for English” then “Press 5 for Benefits”, then to hear “you’re now number 37 in the queue” followed by elevator music on a loop…………………

Sound familiar?  

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Battle Lines Forming – Group vs Individual Health Insurance

The explosive growth of ICHRA, an attractive and affordable alternative, an escape from the punishing grip of increasingly onerous government mandates and sanctions, has caused fear among status quo vested interests.

The Partnership For Employer-Sponsored Coverage is Ceausecu on the balcony extolling status quo virtues while having no inkling nor understanding of what is about to come. They are blind and deaf, lost in their own fantasies, out of touch with restless constituents seething with pent up rage.

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Navigate Complex Insurance Policies with Confidence and Avoid Costly Coverage Errors

et current and immediate answers to specific claim and policy questions with FC&S Expert Coverage Interpretation — a unique, online resource designed for those who have a demand for highly complex and hard to find, quality information for specific claim needs and questions.

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Cash Pay Health Care Is The Future

Disrupt Payment Cycles

Real-Time Payments:  Immediate settlement of medical bills at the point of care, eliminating delays and reducing administrative burdens.

Simplified, Transparent Billing: Consolidated, easy-to-understand bills with upfront cost estimates, enhancing patient financial management.

Automated Insurance Integration: Seamless integration with insurance for real-time coverage and out-of-pocket calculations, reducing errors and manual processing.

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$96 Million Pig Factory Comes To Houston

The reported 77,448-square-foot facility could host up to 200 animals.

Now Looney said she feels like a “Superwoman“after the successful transplant, laughing about outpacing family members on long walks around New York City.

“It’s a new take on life,” she told the Associated Press.

Dr Montgomery said, “If you saw her on the street, you would have no idea that she’s the only person in the world walking around with a pig organ inside them that’s functioning.”

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Fee-For-Service Primary Care VS Direct Primary Care

Fee-For-Service American Health Care: You wait for appointment days and weeks later, arrive on time and wait, and wait, and wait in germ infested waiting room full of coughing, wheezing sick and contagious people. You’re finally called to the back, asked a few questions, then left in a 200 square foot room with the door closed under the promise “the doctor will be right in.” More waiting, counting minutes, then counting floor tiles, then focusing attention on memorizing anatomy charts on the wall, then waiting, waiting and more waiting. Then the doctor bursts in with “Hi, what brings you in today?” You explain for the third time why you’re there. Five minutes later you’re escorted to the exit clerk with a prescription in hand. You pay your copay. You are released to leave. You’re cured.

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Meet Your New Healthcare Practitioner

H.R.238 – 119th Congress (2025-2026): To amend the Federal Food, Drug, and Cosmetic Act to clarify that artificial intelligence and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the State involved and approved, cleared, or authorized by the Food and Drug Administration, and for other purposes. | Congress.gov | Library of Congress

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New Era TPA Transitions “Claims” Into Card Transactions At Point of Service

Cash pay health plans in the beginning were an ad hoc out-of-contract seat-of-the-pants claim settlement process on a hit and miss basis without any rhyme or reason. Then as time passed by someone thought to memorialized the process within plan documents supported by outside phone banks manned by “care navigators” authorized to negotiate cash settlements with providers through single case agreements, a not so perfect nor consistent process. Then along comes Yuzu Health founded by three youngsters fresh out of nowhere………….

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Why Virtual Cards Are the Future of Healthcare Payments

Authors: Blake Sorrell, Director, Healthcare Banking, and Jordan Miller, Director, Commercial Account Management

Despite the fact that healthcare providers operate in an industry with historically tight margins, only 16% use automated accounts payable processes. Most providers rely on manual healthcare payments like checks, despite the high costs involved, and organizations can expect to spend $38 on average to manually process a paper check and invoice. In addition, vendors wait on average 34 days to receive payment, putting providers at risk of supply chain interruptions that could place patient and employee safety at risk.

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Enrollment In Largest Risk Pool In Texas Up By 13.8%

TML, TAC and TRSAC combined membership is but a fraction compared to the largest government supported risk pool in Texas.

More employers are ditching traditional group health insurance plans in favor of ICHRA fascillitated risk pool access. At 3.9 million members this is one of the largest health insurance risk pools on the planet.

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Plan Sponsor Fiduciary Liability Insurance

Angry School District Employees Confront District Trustees

Fiduciary Liability Insurance – Here’s why you need it……………….

A self-funded Texas school district provides a group heath insurance plan which incorporates a proprietary PPO network. School district trustees have no idea what they have committed to paying PPO network providers thereby purposely unable to fulfill their fiduciary duties.

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MedSave Management Cash Back Medical Plan

Tier 1               Cash Card                                                           100% to $4,000

Tier 2               Virtual Primary Care                                        100%

Tier 3 *             Deductible                                                          $8,000

Tier 4               Plan Pays                                                             100%

□ Plan Allowed Amount is based on Reference Based Pricing metrics.

□ Rx limited to $640 for a 30-day supply.

□ All specialty & facility care must be pre-certified

□ Plan is excess coverage to IRC501r

□ Plan members participate in year-end plan surplus

□ * Compassionate Care Plan™ option for those plan members who qualify

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ACA Premiums Expected To Increase 75% If………………

“If enhanced subsidies are not renewed by Congress and are instead allowed to expire at the end of 2025, ACA enrollee premium payments are expected to increase by over 75% on average……………”

(THIS DOESN’T MEAN PREMIUMS WILL INCREASE PER SE, ONLY THE ENROLLEE’S COST WILL INCREASE IF THE SUBSIDY (WELFARE) PAYMENT ENDS)

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Federal Trade Commission Report On Specialty Generic Drugs Will Curl Your Toenails

“A Growing Profit Center for Vertically Integrated Pharmacy Benefit Managers”

“The Big 3 PBMs’ affiliated pharmacies generated significant and growing levels of revenue in excess of estimated acquisition cost (NADAC) on the most highly marked up specialty generic drugs…………… the Big 3 PBMs also appeared to take in significant income from spread pricing………….plan sponsors in particular should be aware that they and their members are paying the Big 3 PBMs and their affiliated pharmacies very significant markups over the acquisition costs for critical medications.”

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Heuro Health’s Obesity & Diabetes Management Program Can Make A Difference

By Jeff Bernhard, President Heuro Health

Yesterday, I had the privilege of speaking with one of our patients who is currently on our weight management and lifestyle program and Journey. This individual also has pre-diabetes and has spent years trying to improve her health by losing weight. She shared her satisfaction with Heuro Health, praising the structured nature of our program and how easy it was to access the care she needed. Our dietitians, coaches, and obesity-trained doctors all worked seamlessly together to support her while she is on weight loss medication.

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Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

The Biden Administration provided in a recent press release that the CFPB or the aptly titled “Consumer Financial Protection Bureau” is finalizing a rule to remove all medical debt from consumer credit reports AND to prohibit unpaid medical bills from preventing access to credit. The devil is always in the details: 

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Dr. Bill’s Urgent Care Visit

By Bill Hennessey, M.D.View my services

Sanford Health Bills Incorrectly and Excessively for an Urgent Care Visit

One hour and 4 departments later in a Sanford debacle, after encountering multiple lies, I was told that for a NEW urgent care visit the billing code would most commonly be 99124, which is a CPT code for a FOLLOW UP visit, even as per what they just USPS mailed me. Note further I was verbally told that $346 was “the starting price and depending on what was done it could go up to $800.”

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Frontier Direct Care Announces Initial Closing of its $20 Million Series B Financing

HARLINGEN, Texas, Jan. 8, 2025 /PRNewswire 

Frontier Direct Care, a leading innovator in employer-funded healthcare, has announced the initial closing of its $20 million Series B funding round, led by Mehshah Capital. This investment will accelerate the company’s mission to transform healthcare by delivering accessible, affordable, and high-quality care to employees and their families.

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Important Notice for Members with Serious Medical Conditions

“It’s never been our intent to hire a walking, breathing million-dollar claim liability” purrs the nice HR lady during orientation. “We operate under a “No Ask, No Tell” doctrine in order to avoid discrimination lawsuits, But………..we have a really sneaky solution and your job depends on it!”

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