June 2025 – Risk Managers

The Jacked Up World of Cost Containment

Victor Lustig

The American health care delivery system is about as jacked up as jacked up can get. Employers scramble to mitigate rising health care costs by hiring outside cost containment firms employing any number of strategies. This additional plan expense can effectively double or triple fixed costs leaving fewer budgeable dollars to pay claims.

Telemarketing Script Kills It

Attention Insurance Salesmen! Try this script and increase your sales overnight!

How Is This Legal?

How is this legal?

How Much Does An ER Visit Cost?

By Josh Nakka

Most people guess a couple thousand dollars, but the reality can be far more shocking. An ER bill can sometimes top $20,000.

Script Sourcing Third Party Vendors Save Plan Sponsors Millions In Prescription Drug Spend

PBM Sales Rep. Reacts To The News……………….

Plan sponsors seeking solutions to high cost prescription drugs must understand a single source solution is not their best bet. Lowering Rx costs is all about sourcing the right drug at the right price. It’s that simple.

How To Convert A Fake Billed Charge To A Real Price In Seconds

“Everyone knows a billed charge is bull shit. It’s like a sticker price on a new car. No one ever pays full billed charges unless they are brain dead. Leon has developed an AI tool that cuts through the bull shit” – Bill Rusteberg

Normandy Seeking P&C Agents

You read that right. Three simple steps, no premium commitment, and you’re getting appointed today.

Missing Toothbrush Found After 52 Years

Chinese man, 64, finds toothbrush he swallowed at age 12 stuck in intestine, needs surgery

The Cash Pay Revolution Continues

“Cash has more power and influence than a health insurance card with a logo” Molly Mulebriar

The Curative Zero Card has a new name: the Curative Cash Card. Why? Because it now covers even more services, and makes it even easier for members to use their $0 benefits.

Rx Flyer Found In Lonely Rural Mailbox

In a remote part of a South Central Texas county there stands a lonely mailbox, the last one on a rural route 12 miles from a city no one has ever heard of. It’s a window to a wider world of strange and amazing things……………

Carrier Ditches Traditional Group Insurance Plans To Promote ICHRA

Insurance company announces it will exit the fully-insured, self-funded and level funded market to concentrate on individual policies through Individual Coverage Health Reimbursement Arrangements (ICHRA).

“We are committed to helping employers find affordable health insurance options for their employees. We believe that one answer can be found in our individual plans and are excited to provide a solution for employers in CT through an Individual Coverage Health Reimbursement Arrangement (ICHRA).”

Mark Cuban Floats Bold Healthcare Plan: ‘Zero Premiums To Insurance Companies’ With A Cash-Pay Revolution

“This is not a new idea but a good old idea. Cuban proposes the government provide the equivalent of a $50,000 stop loss policy for all Americans – an ACA Re upgrade. Let’s do it!” – Molly Mulebriar

Federal Judge Rules Providers Can Sue To Enforce Unpaid IDR Awards

“Get your check book ready………………” – Don Pedro

Eliott Listman – Allia Group – Litigation CEO

A federal court in Connecticut ruled that providers can sue to enforce unpaid IDR awards under the No Surprises Act, rejecting insurer arguments that there’s no private right of action.

Even The Clouds Know

Picture stolen from Josua R …….

Do we still need traditional PBMs?

“It’s evidently possible to run an effective discount network without the associated bloat and misaligned incentives of a traditional PBM…..”

Bird Dogging Jilted Lovers

ICHRA administrators don’t need brokers but they pretend they do. They often play both sides, direct sales and broker introduced door opener sales.

Nobody Hates Insurers Like Doctors

By Craig Gottwals

“While hospitals and insurers are milking employers for two to six times Medicare every chance they get, doctors get the stuffing kicked from them in the insured market. “

Medicare and Social Security Go-Broke Dates Pushed Up Due To Rising Health Care Costs

Medicare is on track to be broke in eight years. If Medicare For All is implemented then it stands to reason the Medicare risk pool will benefit by the addition of younger and healthier people. Odds makers expect that to happen because it will. Medicare won’t be a risk pool of oldies anymore.

Nothing Is Forever

Government “enhanced” premium assistance for ACA plans is set to expire at the end of this year.

The ER Is Bursting at the Seams — Employers Hold the Key to Change

Employees visit ER “as a quick fix for their healthcare needs, particularly for mental health conditions.”

Curative Insurance Company Lands Large Florida School District

“With employees facing a 20% health-insurance increase, the Volusia County School Board has pivoted away from its longstanding carrier and awarded a $153 million contract to Curative, a startup that’s been in the business for less than three years.”

Houston’s ODPC Beats A Poke In The Eye

Houston Residents Rejoice At The News – 24/7 On Demand Health Care

Need to see a doctor but don’t want to wait days and weeks to see one? Tired of waiting in a crowded, germ filled waiting room filled to capacity with coughing and sneezing sick people whose appointment was booked for the same time as yours, all waiting to see the same doctor while snot nosed kids run around the waiting room playing grab ass?

The Most Outrageous Insurance Salesman That Ever Lived Explains How He Does It…

King Murray – The Most Outrageous Insurance Salesman That Ever Lived! is an interesting character. This video is time stamped where in two minutes he explains his secret for success…………

Build-Your-Own Health Plan

DIY and Stop Feeding the Beast

“If you’ve got access to a savvy self-funded plan backed by direct contracts or Reference-Based Pricing? Take it. That’s the best option in the country right now.”

Pass-The-Hat Risk Management

Hospital Cover Charges & Whorehouse Financing – A true story based on fabricated facts…………

A self-funded health plan that moved away from managed care networks two decades ago knows the secrets of health care finance in this country.

The PBM Survival Kit You Didn’t Know You Needed… But Absolutely Do

By Josua R

Tired of claw backs, DIR fees, and being gaslit by pharmacy benefit managers? Here’s your starter pack for surviving the daily abuse:

Insurance Tomb Stoning

Tomb Stoning is where unscrupulous insurance agents use the names of dead people and create insurance policies for them. Agents often work on large up front commissions so get money almost immediately a new policy is signed.

Does Texas HB 2015 Apply To ICHRA Plans?

And Your Answer Is…………..□ YES □ NO

ICHRA 2026

SOURCE: Venteur

One of the most notable trends in the 2026 filings is the rise of ICHRA-specific plans, which are filed off-exchange only and are priced up to 20 percent lower than their on-exchange counterparts.

$10 Admin + Cost of Risk = Current Cost/4

By Monte Jennings, President Sentia Health

Sentia has automated the entire health insurance process. We provide the EMR to practices, price the procedures 50% ABOVE Medicare, and pay for work performed in real time.

Most Americans Back Trump’s ‘Radical’ Actions To Reform Health Care Industry

The vast majority of Americans support President Donald Trump’s actions to make medical prices more transparent, according to an exclusive poll shared with The Daily Wire.

What’s This Going To Cost Me? Sorry, I Can’t Tell You!

SOURCE : Patient Rights Advocate

New national poll confirms what we’ve known all along: Americans want real prices in healthcare—and they want them before they get the bill.

Prison Inmate Health Insurance

Catastrophic Inmate Medical Insurance

Catastrophic Inmate Health Coverage

SOURCE: ACCG

Catastrophic Inmate Medical Insurance is an insurance policy with a structured reimbursement model for which eligible medical expenses incurred outside the walls of the jail can be reimbursed.

Inmate Medical Insurance

SOURCE: IAT

IAT has specialized in stop-loss insurance solutions for the adult correctional market since 1984. Our Inmate Medical program provides prisons and jails valuable protection against unknown, potentially catastrophic medical claims.

Dental Insurance For Texas Retired Teachers

Texas Retired Teachers Association (TRTA) knows Retired School Employees like you. AMBA knows insurance. Together we can provide you with the dental and vision plans you need to keep your teeth and eyes healthy now and for years to come.

Johnny’s Doctor Is a Little Strange |

Another Rojas Truth Bomb

By Dutch Rojas

Health Insurance Premiums are not high because care is expensive.

Student Accident From Chubb

SOURCE: Chubb

Many schools seek to comply with state educational code requirements and limit their general liability exposure by providing student accident insurance to students in kindergarten through 12th grade.

Capital Rx Introduces Judi

Capital Rx Expands Into Care Navigation with Acquisition of Amino Health

Through a new acquisition, Amino Health will become Capital Rx’s patient-facing care navigation solution called Judi Care.

The Employer’s Dilemma: When the Fully Insured Plan No Longer Works, What’s Next for Employers?

SOURCE: Medcity News
By Ben Light on June 12, 2025

“The results are clear, too. Recent data from Oscar Health(Opens in a new window) shows that the individual market’s vast risk pool — stabilized across over 24 million lives — has not only maintained the cost of health insurance. It’s actually forcing it down, with 2024 costs trending about 4% lower than employer costs.

The Truth About Group Health Insurance

Status Quo Health Insurance Broker Leading His Clients

By Bill Rusteberg

The Land of Lemming is better than the Land of ICHRA” is a common belief. But is it?

BCBS Michigan Sued Over Alleged Scheme to Extract Excessive Fees from Self-Insured Health Plans

Employer Sues BCBS Michigan Alleging Hidden Fees

By Mark Flores – Executive Vice President and Co-Founder at AVYM Corporation

Blue Cross Blue Shield of Michigan is under fire again—this time accused of siphoning off millions in excessive fees from self-funded employer health plans.

Doctor Explains Benefits of Fasting

TESTAMONIALS:

“When i was in college i fasted a lot, the biggest benefit i noticed was a 22% increase in ability to pay tuition”

Unintended Consequences

46 Reasons Why We Can’t Trust The Government To Do Much Of Anything

SOURCE: Sentia Health

“We compiled this list to show that we can’t have the government running any kind of nationalized healthcare program. A nationalized healthcare program like Medicare For All, Beveridge or Bismarck would encompass all the categories we just proved that the government is bad at.”

Is ICHRA a Self-funded Health Plan, or Not?

Source: Ernie Clevenger, MyHealthGuide, with initial inquiry from ChatGPT

Legally, yes, Individual Coverage Health Reimbursement Arrangements (ICHRAs) are classified as self-insured (or self-funded) group health plans because………….

Maxor Changes Name

I Wonder What Jerry Thinks About This?

I’m excited to share with you that MaxorPlus is now VytlOne as of June 9, 2025. You’ll start to see our new name immediately, and members will see our new name closer to the end of 2025.

Fiduciary Liability Insurance Is Now More Important Than Ever

A rising tide of lawsuits sweeping the nation centers upon ERISA fiduciary obligations of employers in their role as group health plan sponsors, particularly the “duty of prudence” in selecting and monitoring health plan vendors. These fiduciary failures harm plan participants and beneficiaries by paying more than they should.

Should Your Health Plan Cover Bad Behavior?

It’s Time To Put Bad Behavior Into Remission – Just Say No To Bad Behavior!

“Why should I pay for this? It’s for a $150,000 hospital bill on Lupita, our 27-year-old accounting clerk in the credit department. Tell the TPA to stop payment!” said Mr. Ruben, the owner of the company.

6th Circuit Court of Appeals Decision Potentially Rewards Billions to Self-Insured ERISA Health Plans

This ruling reinforces the importance for all self-funded ERISA health plans to understand how TPAs manage claims and compensate themselves—especially when such practices may compromise plan integrity and violate fiduciary duties.

The Great American Healthcare Heist

What Radicalized Me? (4 of 11)…………I explain this concept a bit more in this article if you want more than just this slide: The Great American Healthcare Heist: A Saga of Overpayment and Underperformance……….

School Board Member Voices Concerns With Insurance Bidding Process

Article Referred By Alex Zuniga

“Gutierrez, represented by attorney Samuel Reyes, alleges that she voiced concerns with the bidding process for insurance contracts for the district..”

We Only Want The Best For Our Employees!

“We care about our employees! We want the cheapest insurance money can buy! There’s no limit to how much we can save and we’ll spend it until we get there!” says the nice HR lady in between calls from angry plan members.

Why The Difference Between Cancer & Diabetes Treatment?

“Why do doctors and the healthcare system treat most cancers to get the patient into remission from cancer, but doctors and systems do not treat type 2 diabetic patients to achieve remission, but instead to live with the condition?” – Jeff Bernhard

Now You Have It, Now You Don’t

The enhanced premium tax credits (Welfare Assistance) are now set to expire at the end of 2025. Unless the Welfare Assistance (premium tax credits) are (is) extended, consumers can expect (Humongous) increases in both the net premium payments and gross premiums:

Meanwhile his surgeon prepares. Next day in the operating room…………