Self-insured Employers Must Remake Healthcare As The BBB Upends The Market

The Bottom Line: Employers must seize control now, ditch the legacy models, or keep paying more for less.

In July 2025, the Big Beautiful Bill became law, eliminating approximately 15% of government spending on healthcare………………..

Employers have a choice: stick with the known devil, paying higher YoY prices for declining value, or embrace the unknown angel, unlocking the potential of new models that enable better health at a lower cost for a whole new generation of health consumer employees. The best option could not be more obvious.

Dr. Choke’s Amazing Obesity Study Brings Hope To Millions

Art A. Choke, M.D. has concluded a study to determine the causes of the obesity epidemic in the United States. His amazing findings, if correct, provides clues of how the obesity epidemic can be eliminated.

Why Covid Is Spreading Again This Summer

Researchers are seeing an uptick in cases, as they have every summer since the pandemic began. Here’s why.

The No Surprises Act Doesn’t End Balance Billing – It Turbocharges It

The No Surprises Act (NSA) doesn’t end balance billing. It simply passes the liability from Joe Sixpack to deep pocketed plan sponsors. The sad news is………the Joe Sixpack’s out there end up paying for it all anyway in the form of higher insurance premiums.

Oldest Drugstore In Texas Closes After 180 Years

Reuss Drugstore – Cuero, Texas

Established in 1845 Reuss Drugstore closed for good this week. There are no more home-grown independent pharmacies left in the small town of Cuero, Texas anymore.

$5,000 Annual Dental Plan For $41.58 Per Month

NO Waiting Periods and NO Deductibles
$5,000 Dental Plan (per calendar year, per covered family member)
Large National PPO Network
Implants Covered on Major Services
For Individuals and Employer Groups of 2+
Fully insured by – A.M. Best Rated Insurance Company

Give to the Employee Emergency Fund

Help for Life’s Unexpected Emergencies

It’s more important than ever to support our hardworking employees. If you are in a position to do so, please consider donating to Austin Community College’s Employee Emergency Fund, which supports grants and loans to assist ACC employees when needed. The fund was created in partnerships by ACC’s employee associations to provide immediate financial assistance to employees experiencing an unexpected hardship.

Chat With A Doctor Online Without Leaving Your House

Thousands of Highly Rated, Verified Doctors

Specialties include: General Medical, OB-GYN, Mental Health, Pediatrics, Urology, Dermatology, Dental, Oncology, Bariatrics, Neurology, Cardiology, and more.

Substance testing & interactions, blood pressure, tooth pain, skin problems
Specialties include mental health, pregnancy, dental health & more
Connect directly with Doctors upon joining.

MedSave’s $5,000 Dental Plan Now Available For Association Sponsorship

M.D. Hotline Lowers ER Visits By 70%

Have you ever…

Needed a doctor in the evenings or on the weekends?
Needed a prescription called in to your pharmacy?
Needed to talk to a doctor about a non-emergency illness?

Don’t Worry Sir, You Have Insurance

How many times have you heard “Don’t worry Sir you have insurance!”

Mitigate Partners & Alicorn Forge Strategic Alliance To Power Up Employer Health Plans

You don’t need to read the rest of this blog entry, just watch this two minute video.

Coalition For Education Funding Annual Conference

CEF ANNUAL CONFERENCE – DEC. 10-11, 2025 – WESTIN SOUTHLAKE – SOUTHLAKE, TEXAS

Does Your Hospital Owe You Money?

Need help with a hospital bill that you can’t afford to pay? Go HERE to see if you qualify

You just left the hospital. “Thank God I had insurance” you thought.

Days and months later you get phone calls and bills in the mail. “You owe $4,345.09!” says the hospital bill collector. “Pay it or we will take your first born!”

Ex-MD Anderson scientist accused of stealing trade secrets for China

By FOX 26 Digital and Abigail Dye – Published August 25, 2025

Ex-M.D. Anderson researcher accused of trying to steal trade secrets

An international investigation is underway after authorities say a local scientist tried to steal cancer related research from top medical institutes here in Houston and then send it to China. The suspect worked at MD Anderson and is now in custody.

The Charity Care Mirage

60% of Hospitals Overbill Working Families

The charade of hospital chargemaster (retail) pricing and commercial discounts to the big four health insurers has to be the most prominent instance of kabuki theater in American business. Hospitals regularly bill eight to ten times what Medicare would pay, “discount” that 50 to 60% to insurers, and squeal like stuck pigs when employers seek to pay them 140% to 180% of Medicare.

Orforglipron The New Oral Weight Loss Drug Is On The Way For Approval

Eli Lilly’s weight loss pill orforglipron clears its latest trial, paving way for approval

By Annika Kim Constantino

Key Points

Eli Lilly on Tuesday said its daily obesity pill succeeded in another late-stage trial, helping patients with obesity and Type 2 diabetes lose weight and lower their blood sugar levels.
The company now has the full clinical trial data required to start filing for approvals of the drug for chronic weight management with global regulators.
The rate of side effects and treatment discontinuations in the study, called ATTAIN-2, appeared to be generally consistent with two recent phase three trials on the pill, called orforglipron.

THE TOO GOOD TO BE TRUE HEALTH PLAN FOR TEXAS EDUCATORS

Best Health Plan Texas Educators Have Ever Had and We Can Prove It!

Woman Undergoes Face Lift To Overcome ‘Ozempic Face’

Kimberly Bongiorno, 55, turned to plastic surgery to help with changes to the appearance of her face and neck after using Ozempic for weight loss.

The 340B Program Explained

By:Alexandra Murphy – August 21st, 2025

More than three decades ago, Congress created the 340B program to help safety-net hospitals and clinics expand resources and care for underserved communities.

Same Surgery But $220K Apart

“The amount that the procedure will cost depends on who is paying. No other industry works that way”

Blue Cross $2,800,000,000 Antitrust Settlement

Who’s gonna pay for this? – Joe Sixpack

MD Anderson’s Financial Assistance Policy

A family of 1 earning less than $62,600 may get free care at MD Anderson.

Texas Counties May Find It Harder To Meet Budgetary Needs

County Official Appeals To Taxpayers For More Property Tax Money

Texas House Approves Bill Aimed To Limit City, County Property Taxes

“I don’t see how there’s not a public safety hit that our local governments are going to take and then they’re going to have to go to the voters every year simply to approve maintaining existing fire and police staffing levels,” said state Rep. Chris Turner, D-Grand Prairie.

Attn. Plan Sponsors: Have You Had Enough Yet?

By Craig Gottwals

80–90% of hospital bills contain errors.

One of the most undervalued aspects of an open-access, self-funded plan backed with reference-based pricing is that we are not limited in our audit capability. You see, many (if not all) of those PPO arrangements you purchase when you “self-fund” with a national carrier severely limit your ability to audit their work.

This Parasitic Worm Might Be the Future of Painkillers

“This parasite snips the wires on your internal alarm system before walking into the front door.”

One Of My Biggest Regrets As A Former CFO

By Author Unknown

In my 30 years working in CFO and senior finance roles, I never got involved in the design or operation of the employee benefits plan. I (incorrectly) assumed this was the exclusive territory of HR.

Aldeen’s Sunday Morning Bathroom Read

Manipulating the No Surprises Act – A recent study noted “that the median IDR decision is at least 3.7 times what Medicare would pay” and “that IDR entities are selecting the provider’s offer more than three-quarters of the time.”

Turn Right Pay $500, Turn Left Pay Nothing

A rural out-of-town 157 life group health plan in deep South Texas incurred 98 budget busting ER visits during the past 12 months most of which could have been avoided.

Direct Primary Care For Yacht Owners

Dr. Alexander Golberg treats Abe and Giovanna Haruvi aboard a yacht in Sag Harbor.

“For everything from aesthetic touch-ups to 9-1-1 emergencies, the wealthy are calling on providers who charge membership fees ranging from a few thousand dollars to six figures a year.”

Ozempic Teeth

Ozempic Teeth: Dentists Warn of New GLP-1 Side Effect

(NEXSTAR) – Patients using Ozempic and other GLP-1 drugs are reporting a complication not listed among the drug’s most common side effects. (We’re not talking about “Ozempic babies,” but that’s also a thing.)

Just Another Day In Renewal Season

A Day In The Life of An Independent Pharmacist

By Josua R

Imagine this: You walk into Target, grab a cart full of stuff — clothes, electronics, food — and at checkout the cashier says:

“Don’t worry, we’ll pay for it. Hopefully we’ll get reimbursed in a few weeks… but probably for less than what it cost us.”

A Picture Is Worth A Thousand Words

Wellness Program Claims 45% Reduction In Health Care Costs

“Their program focuses on making behavioral changes to help improve your sleep, nutrition, stress, and more – all while prioritizing sustainable, long-term results.”

Indecision Costs You The Same As Fear

By Craig Gottwals

In this case, a cool $64 million over the next 11 years awaits. Will you seize it?

World’s First Spinal Cord Transplant

World’s First Spinal Cord Transplant to take place in Israel, could allow patients to walk again

Tel Aviv University announced on Wednesday that the surgery will take place in Israel, marking a historic milestone in regenerative medicine.

Important Message From ScriptSourcing

Beginning August 29th, the U.S. government is expected to impose a flat tariff of $80–$240 per shipment on medications imported from Tier 1 countries (Canada, the United Kingdom, Australia, and New Zealand).

Opportunity For COBRA Administrators! BCBSTX Creates Modern Gold Rush

Effective January 1, 2026, Blue Cross and Blue Shield of Texas and Illinois will exit the COBRA/DB Administration market.

Government Decides Not To Enforce STM Duration Limits

“On August 7, 2025, the Centers for Medicare & Medicaid Services (CMS) announced it will not enforce the 2024 STM duration limits while reviewing rules—opening the door for states to allow short-term medical plans lasting up to 12 months and renewable for up to 3 years.”

Marpai Cuts Operating Expenses By 70%

“We believe that our turnaround is real and accelerating,” said Damien Lamendola, Chief Executive Officer of Marpai. “In just one year, we have significantly strengthened our financial position by cutting costs, streamlining operations, and staying laser-focused on profitability.

More Consumers Shop Insurance Without An Agent

INSURANCE AGENTS LINE UP FOR JOB FAIR INTERVIEWS

“Direct distribution channels continued to pull ahead of agent-driven sales. Shopping through direct carriers jumped nearly 23% year over year, boosted by aggressive marketing and a loosening of risk appetite. “

Government Sponsored Risk Transfer Strategy For High Risk Group Plan Members

Plan sponsors would be wise to schedule a special open enrollment period matching the ACA open enrollment period.

Medicare Annual Election Period 2025

Medicare’s Annual Election Period (October 15 – December 7) is right around the corner—and this is your chance to get prepared.

Theves With A Halo

By Dutch Rojas

Nonprofit hospitals give less charity care than for-profits and they still pocket billions in tax breaks.

Girls Will Remain Girls, Boys Will Remain Boys Under Government Health Plan

Government Employee Jack “Jacqueline” Smith Responds To The News

“For Plan Year 2026, chemical and surgical modification of an individual’s sex traits through medical interventions (to include ‘gender transition’ services) will no longer be covered under the FEHB or PSHB Programs.

Redacted Email From Friendly BUCA Rep.

This is a Dog! Don’t you ever, ever send something like this again!

Meet the Companies Scaling at Hyper Speed

Inc. 5000

Companies on the 2025 Inc. 5000 list are ranked according to their percentage revenue growth over three years, from 2021 to 2024. To qualify, companies must be privately held, for-profit, based in the U.S., and independent (not subsidiaries or divisions of other companies) as of December 31, 2024.

BillingNav Appoints Doug Aldeen as General Counsel to Bolster Legal and Compliance Expertise

Doug Aldeen – General Counsel – BillingNav

SOURCE: BillingNav 8/13/2025

ATLANTA– BillingNav, a leading provider of services addressing balance bills, credit reporting correction, and the No Surprises Act (NSA), announced the appointment of Doug Aldeen as its new General Counsel, effective August 4, 2025.

Leave It To Beaver

“You don’t always need a new idea. Just fix a problem that everyone else ignores.”

Don Pedro Wants To Know Why…..

94% or private health plans continue to subscribe to managed care networks they can’t see nor audit. Someone else is deciding what prices consumers must pay for health care and insurance companies make sure they do.

Uncle Miltie

Milton Godwin, affectionately known by those of us back in the day as Uncle Miltie, was an aging Houston insurance agent back in the 80’s who specialized in bidding on cities, counties and school districts.

Optum Acquires Holston Medical Group Expansion

Corporate controlled health care continues to expand.

“The acquisition brings together two healthcare organizations with aligned visions for delivering exceptional patient care. Holston Medical Group’s integration into Optum’s network promises to enhance healthcare delivery capabilities while maintaining the personalized care that local communities have come to expect.”

The Omaha Whiz Kid Buys 5,000,000 Shares of UHC

Warren Buffett’s Berkshire Hathaway reveals new stake in beleaguered insurer UnitedHealth.

High Cost Claim Diversion Strategy Saves Plan Sponsors Big Bucks

Patient dumping or smart risk management? Are lasers relevant anymore? The HOT POTATO risk transfer method……………….

Is Your Insurance Agent Licensed?

Go to Compliance Express ™.

All Family Pharmacy

Paxton Accuses Drug Manufacturer of Bribing Providers in Texas

Does Sunrise Lee have anything to do with this? She knows how to sell doctors on high cost drugs. Back in the day that was her thing………………..

Frontier Direct Care Named One of America’s Fastest-Growing Private Companies on Inc. 5000 List

PR Newswire – August 12, 2025

Direct Primary Care (DPC) provider ranks #464 in its inaugural listing and is in the top 50 in the healthcare industry and top 50 in Texas!

Cowboys’ Jerry Jones Says ‘No Tumors’ After Stage 4 Melanoma

By Todd Archer – SOURCE:ESPN

OXNARD, Calif. — Dallas Cowboys owner Jerry Jones said that he has dealt with Stage 4 melanoma and that an experimental trial drug saved his life.

The Shadow War Beneath Our Healthcare System

“A quiet guerrilla war rages in the sewer system undergirding U.S. healthcare……a bare-knuckled, animosity-filled, back-alley brawl…”

What Is An Actuary?

How do we know we are doing much better this year than last year?
What was this year is the last year plus or minus this year’s change.
If change is the only constant why do we need to measure it? You don’t know if something is better if you didn’t know how to measure what it was before.

If Health Care Middlemen Ran An Ice Cream Truck

“This is the only ice cream truck with a collection agency” – Bill Hennessey M.D.

Pharmacy Prior Authorization Form

By Dr. Maurice Shaw on LinkedIn

If we created prior authorization for customers to transfer to your pharmacy

Do Not Let Your Children Click On This Link

The $58B Weight Loss Drug Market in One Chart

By Julia Wendling – SOURCE: Visual Capitalist

The $58B Weight Loss Drug Market in One Chart

Weight loss drugs have surged in popularity in recent years, transforming the pharmaceutical landscape. Companies leading the charge in GLP-1 development are reaping massive financial gains and wielding growing influence.

The $5.6T Pharmaceutical Industry in One Chart

By Julia Wendling – SOURCE: Visual Capitalist

The $5.6T Pharmaceutical Industry in One Giant Chart

Pharma giants don’t just make medicine—they shape the future of healthcare. From determining which treatments reach patients to setting costs and driving innovation, their influence extends across both health outcomes and financial markets.

El Paso Hospital CEOs In Big Trouble

El Paso hospital CEOs allegedly committed insurance fraud, indicted on federal charges

$161,000,000 ACA Enrollment Fraud Scheme

President of Insurance Brokerage Firm and CEO of Marketing Company Charged in $161M Affordable Care Act Enrollment Fraud Scheme

Lubbock Cardiologist To Pay $1.2M For Illegally Prescribing Opioids To Himself

Logan Washburn – Staff Writer

A Lubbock cardiologist has agreed to pay $1.2 million to resolve allegations that he issued prescriptions for opioids and other drugs to himself.

Plan Documents Are Made To Be Broken

One Of the biggest problems With Self-Funded Health Plans is the abuse of discretionary authority.

Texas Surgeon Says UnitedHealthcare Dispute May Force Her Into Bankruptcy

Dr. Elisabeth Potter says bankruptcy could loom if the insurance giant doesn’t accept her clinic.

By By Berkeley Lovelace Jr., Priscilla Thompson, Carla Kakouris and Jessica Herzberg

In January, Dr. Elisabeth Potter said she was midway through performing a breast reconstruction surgery when a call from a representative from UnitedHealthcare came into the operating room. The health insurance company wanted to talk about the patient on the table.

Americans’ Ultraprocessed Diets

Ultraprocessed foods make up the majority (55%) of Americans’ caloric intake, according to a study released yesterday by the Centers for Disease Control and Prevention. While the agency has surveyed Americans’ nutrition since the 1960s, the latest report is the first to analyze ultraprocessed food consumption.

Closing the Primary Care Gap

August 7, 2025 – By Jeffrey A. Singer – SOURCE: Cato

With wait times for primary care averaging nearly three weeks, states should consider removing barriers that prevent qualified non-physician practitioners from filling the gap. Yet just over half the states allow nurse practitioners to practice independently.

Diabetes Expert To Speak At Phoenix Event

Diabetes Technology in Hospitalized Patients During Cancer Treatment

Monday, August 11, 2025

Marjorie is a diabetes expert. A Brownsville, Texas native she works for M.D. Anderson – Houston and is scheduled to speak at the ACDES25 conference in Phoenix, Arizona this weekend. (She is our favorite daughter).

The Bottom Line: Employers must seize control now, ditch the legacy models, or keep paying more for less.

Help for Life’s Unexpected Emergencies

Thousands of Highly Rated, Verified Doctors

Have you ever…

Needed a doctor in the evenings or on the weekends? Needed a prescription called in to your pharmacy? Needed to talk to a doctor about a non-emergency illness?

Inc. 5000

The $58B Weight Loss Drug Market in One Chart

The $5.6T Pharmaceutical Industry in One Giant Chart

Diabetes Technology in Hospitalized Patients During Cancer Treatment

Needed a doctor in the evenings or on the weekends?
Needed a prescription called in to your pharmacy?
Needed to talk to a doctor about a non-emergency illness?