
By Bill Rusteberg
Selling information is big business. Take hospital pricing for example. Government diktats mandate hospitals must provide pricing transparency in the form of “Machine Readable Files.”
Continue reading What’s Your Data Worth?
By Bill Rusteberg
Selling information is big business. Take hospital pricing for example. Government diktats mandate hospitals must provide pricing transparency in the form of “Machine Readable Files.”
Continue reading What’s Your Data Worth?
Understand every contracted rate and claim in your market. Level the playing field and turn negotiations into partnerships
Continue reading Price Transparency Is Here
Save up to 20% on your business insurance. Get a quote and get covered online in minutes.
Continue reading Buy Workers Compensation Insurance Online In 5 Minutes
Many employers are struggling to access their medical claims data from vendors. However, those who do have access are more likely to implement strategies to combat healthcare costs.
Continue reading A Third of Employers Can’t Access Medical Claims Data from Vendors, Survey Finds
By Bill Rusteberg
There exists among almost every group health insurance plan a Fifth Column, a small group of insiders whose quiet activities work against the principal of the greatest good for the greatest number.
Continue reading Plan Sponsors Beware! Dependent Coverage Is Your Fifth Column
Want to know if the government thinks your group health insurance is affordable or have you figured that out yourself? Has your family coverage cost become like a second mortgage?
Continue reading Is Your Group Plan Affordable?
58% of risk pool members pay less than $10 per month……………
Continue reading Largest Risk Pool In Texas Covers 4.2 Million Texans
Battling to regain its market share over rival Eli Lilly, Novo Nordisk announced Tuesday that it will reduce the list prices of its popular weight loss drug Wegovy and diabetes drugs Ozempic and Rybelsus by up to half starting in 2027.
Continue reading Novo Nordisk to slash Ozempic and Wegovy list prices by up to 50% for 2027
International | Right to Life UK | Feb 20, 2026 | 2:53PM | Ottawa, Canada
People in Canada are having their lives ended by assisted dying on the same day that requests are made, adding to fears that wrongful deaths may be occurring.
Continue reading Canada is Killing People in Assisted Suicide the Same Day They Request It
By Craid Gottwalls
The No Surprises Act was designed to protect patients from unexpected medical bills. That is a noble goal. The mechanism created to settle those out-of-network claims, known as Independent Dispute Resolution, is having a very different effect. It has become an inflationary engine for the entire healthcare system.
Continue reading THE IDR BLUES
By Josh Nakka | Healthcare Market Intelligence – Visit my website
More than 60% of UHC’s physician group E/M contracts are below Medicare.
Continue reading More than 60% of UHC’s Physician Group E/M Contracts Are Below Medicare.
It it’s true 80% to 90% of people never hit their deductible that means they’re paying for 100% of their care……..in cash.
Continue reading 80-90% Of Health Plan Members Pay Cash For Health Care
Is Your Family Health Insurance Too Expensive? Go here & we’ll calculate cost saving options that may stun you…….and government subsidies you may qualify for. “It’s always in your best interest to be aware of quality options”
4.2 million Texans enrolled in ACA Marketplace plans for 2026 with 97% receiving premium tax credits.
Continue reading Amazing Alternative To High Cost Group Family Coverage
Hey Doc! What’s your best price? I’ve got cash!…………………..It’s your choice!”
Continue reading Cash Pay Health Plans Made SimpleDreading another reporting season? WEX can help.
Continue reading Say Goodbye to ACA Reporting Headaches
“San Felipe Del Rio CISD believes that access to quality health care for its employees and their families is of great importance.”
Continue reading San Felipe Del Rio ISD Goes from Self-Insured to Fully Insured
“Overnight, the government created a $5 billion market, sanctioned employer balance billing (with an 83% success rate for providers) and gave a 3x-4x pay raise to folks subject to the NSA/IDR regulatory framework. The NSA/IDR process is not a way to occasionally resolve reimbursement disputes. It is a business model.”
Continue reading Aldeen’s Sunday Morning Bathroom Read – NSA Edtion
By Molly Mulebriar
Jorge is a devoted employee of the McAllen Independent School District in deep South Texas and like many other working Americans he struggles to pay for family health insurance for his wife and two children. The district offers a generous health insurance package but his cost to add his family is a hair above 9.2% of his annual household income. It’s a second mortgage he can’t afford.
Continue reading McAllen ISD Employee Saves $8,796 On Family Health Insurance
MyHealthGuide Source: Xchange Benefits, 02/18/2026
ARMONK, NY — Hammurabi, a division of accident and health managing general underwriter Xchange Benefits LLC, a subsidiary of Octave Specialty Group, Inc. (NYSE: OSG), has unveiled an artificial intelligence platform that fundamentally transforms how medical stop loss insurance is underwritten, replacing a traditionally labor-intensive process with near-instant risk prediction and pricing accuracy.
Continue reading Hammurabi, a Division of Xchange Benefits, Unveils AI Platform That Revolutionizes Medical Stop Loss Underwriting
By Molly Mulebrar
Jorge is a devoted employee of the Brownsville Independent School District in deep South Texas and like many other working Americans he struggles to pay for family health insurance for his wife and two children. The district offers a generous health insurance package but his cost to add his family is a hair above 9.12% of his annual household income. It’s a second mortgage he can’t afford.
Continue reading Brownsville ISD Employee Saves $7,597 On Family Health Insurance
We get solicitations to sell various insurance products and services every day. Our mailbox receives more than one a day. We enjoy reading the “Pitch” designed to grab attention. You gotta love these marketing efforts. This is the latest……………….and it’s a great “Pitch.”
Continue reading Dental: The Coverage Agents Love to Hate (But Shouldn’t)
Cash pay health plan strategies in the United States is becoming popular. But did you know the scheme has been in practice for decades across the pond? The English have been decades ahead of us.
Continue reading Medicash
By Molly Mulebriar
Family health insurance premium is too damn high! Family coverage through employer sponsored health plans is out of reach for many working Americans.
Continue reading Are You Fed Up & Not Going To Take It Anymore?
Keep your deductibles high when you’re forced into the fully insured viper’s den, and lower the deductibles as much as your budget will allow when you self-fund.
Continue reading HIGH OR LOW DEDUCTIBLE PLANS?
Start Health is a reimbursement policy (Indemnity Plan), not traditional insurance. We reimburse fixed amounts based on your care, which gives you the freedom to choose providers and control costs. As the only reimbursement plan that’s designed to be HSA-eligible, you can also pay tax-free with your Start HSA Card, combining flexibility, transparency, and savings.
Continue reading How a Cash-Pay, Reimbursement Model Works (And Why It Can Save You Thousands)The DOL’s proposed regulations establish new disclosure and audit requirements for “covered service providers” that enter into contracts or arrangements with self-insured group health plans and reasonably expect to receive $1,000 or more in compensation in connection with providing pharmacy benefit management services or providing advice, recommendations, or referrals regarding the provision of such services.
Continue reading Proposed PBM Fee Disclosure Regulations – A Major Gamechanger
By Ginny Crisp
Generic drugs cost pennies to make. So why does your plan sometimes pay dollars?
Continue reading Generic Drug Pricing: What’s Below The Surface
By Marcus Greene – Founder, Saidi Health
After 15+ years in this industry, I’ve learned something important: most of the biggest opportunities in insurance don’t come from new products — they come from fixing problems employers didn’t even know they had.
Continue reading ICHRA – Medicare: Here’s A Plan You’ve Never Heard Of Until Now
by: Kevin Baskar Feb 17, 2026 – Article Referred By Brent Evans
ROUND ROCK, Texas (KXAN) — Round Rock ISD (RRISD) is opening a new employee health center for the district’s staff and family members amid rising health care costs.
Continue reading Round Rock ISD Opens New Employee Health Clinic To Combat Rising Insurance Costs
SOURCE: Directhealthplan.com
Direct Health Plan is a complete solution for self-funded employers in need of an employer health plan.
Distribution: Direct to employer and select broker partners across the United States.
Continue reading Drop The Middlemen – Choose Direct
“TRS-ActiveCare is not financially self-sustaining and survives only through recurring taxpayer subsidy and ongoing cost shifting to employees.”
Continue reading TRS-ActiveCare: What the February 12, 2026 Board Materials Actually Reveal
Joe finally gets the bass boat he’s always wanted but could never afford until now………..
Continue reading TRS ActiveCare Members Struggle to Afford Family Coverage
SOURCE: EZaccessMD
EZaccessMD has an average client utilization rate of 70% (and climbing). That’s more than 10x the average utilization rate for traditional telemedicine.
Continue reading
Rapid growth government health plan for Texas public school districts renews Blue Cross Contract – More districts believe the Grass Is Not Greener On The Other Side.
Continue reading TRS ActiveCare Renews With Blue Cross
The board reprimanded Dr. Mary Bowden last year after she prescribed ivermectin to a patient at a Fort Worth hospital during the height of the pandemic.
Continue reading AG Ken Paxton Backs Ivermectin Champion’s Fight Against Texas Medical Board
Wall Street and Private Equity are Sweating…………
Continue reading The Institutional Broker/PBM Shadow Economy Hit with a Massive Spotlight
Go Here For Benefit & Enrollment Information (1out of 3 people pay under $30/month)
Continue reading Common Sense Alternative To High Cost Group Dependent Coverage
Article Referred By Lori Ramos
Attorney General Ken Paxton issued Civil Investigative Demands (“CIDs”) to Blue Cross Blue Shield of Texas (“BCBS”) and Conduent Business Services LLC (“Conduent”), demanding documents and information pertinent to the investigation of the Conduent data breach that exposed the sensitive personal data of approximately four million Texans.
Continue reading Attorney General Ken Paxton Demands Information from Blue Cross Blue Shield of Texas and Conduent as Part of Investigation into Largest Data Breach in U.S. History
“Average cash price without insurance= $9.96. Express Scripts Mail Order price= $235.32.”
Continue reading Kimberly Has A Question………
Employer Sponsored Group Dependent Coverage Is No Longer Relevant
“For a lot of families, $15–$25K for dependent coverage isn’t “benefits” anymore — it’s a second mortgage. When ACA marketplace options can deliver compliant coverage with subsidies that drop costs to a few hundred dollars (or less), it’s hard to justify forcing everyone into the group plan just because “that’s how we’ve always done it.”
Continue reading What Traditional Group Insurance Brokers Won’t Tell You
By Pearly Chen
Most people don’t realize that the standard hospital consent forms in ER could commit you to paying full billed charges from the Chargemaster, where prices can be 500% to 1000% higher than what the government or insurers actually pay for the same services.
Continue reading The Blank Check Problem
Want an indication of what your renewal will look like before your broker does? Tired of waiting for last minute renewals giving you no time to shop around for a better deal? Can’t afford the luxury of your own in-house actuary? No worries, meet Your New Best Friend!
Continue reading Tired of Waiting For Renewal Surprises? Meet Your New Best Friend
AI transforms actuarial work, not eliminates it. 22% growth projected through 2034 as AI automates tasks while expanding demand for expertise.
Continue reading Will AI Take Over Actuary Jobs? 2025 Future of Actuaries
Why has this article received so much attention? It’s now 96,817 and growing still.
Continue reading +90,000 In 24 Hours
SOURCE: INSURIFY
Why compare with Insurify?Insurify delivers serious savings with no hidden fees and no catch. We’ve already helped millions of people find exclusive rates and discounts.
Continue reading Compare Quotes In 60 Seconds & Cut Your Insurance Bill In Half
Families cannot afford dependent coverage costing as much as $15,000-$25,000 per year through employer sponsored group health insurance plans. There’s a solution to this madness.
Continue reading Employer Sponsored Group Dependent Coverage Is No Longer Relevant
Texas’ premier historic preservation and heritage tourism conference—presented by the Friends of the Texas Historical Commission in partnership with Phoenix 1 Restoration and Construction, LLC—is shaping up to be our most exciting year yet. Register before the final price increase on March 6.
Continue reading Texas Historical Commission 2026 Conference
By Joshua R.
“PBMs keep saying they ‘lower costs.’ Cool story. Then explain why a $14 medication turns into a $487 charge, why pharmacies get clawed back months later, and why patients, employers, and taxpayers all pay more.
Continue reading How To Catch A PBM
“I’m a supporter of TrumpRx, but they reduce brand prices by 500 percent or 1,000 percent, while ‘CubanRx’ reduces prices by 1,500 percent” – Mark Cuban
Continue reading Mark Cuban Responds to TrumpRX Launch, Says His Cost Plus Drugs Saves More Money
By Doug Aldeen
“If I ain’t getting a 95% discount, I am getting screwed”
Continue reading Aldeen’s Sunday Morning Bathroom Read
By Bill Rusteberg
The economic difference between individual health insurance and group insurance is enough to write home about. Most employers pay nothing towards dependent premium cost while Uncle Sam often does for those choosing individual health insurance plans.
Continue reading Low-Cost Dependent Health Insurance
“These partnerships amount to price-fixing agreements that enable the PBMs to allocate discount card transactions amongst one another in real time, ensuring the PBMs pay the lowest possible reimbursement rates to pharmacies on every transaction“
Continue reading GoodRx, PBMs Accused of Suppressing Reimbursements to Independent Pharmacies
Published Thu, Feb 5 2026
KEY POINTS

“Hospitals already control the claims. Employers already pay full freight. And employers have no negotiating leverage once the claim hits the plan……SwyftScripts does not control prescribing. Hospitals do not control employer savings. And revenue is not driven by utilization expansion, but by reclaiming margin that already exists in the system.”
Continue reading 340b Prescription Drugs – Safety Net or Margin Expansion Strategy?
In just 10 months into a new health plan a small 120 life employer group has paid $56,324.55 for two drugs, (Monjaro and Dupixent) when instead the plan could have paid $26,333.38 for the same drugs, same dosage, from the same manufacturer.
Continue reading Poof, Employer Burns $26,333.38 In Cash – Isn’t That Something?
By Bryce Platt
Most people think PBMs just adjudicate pharmacy claims (if they know what a PBM even is). Here’s how they actually make money.
Continue reading Here’s How PBMs Make Money
Illustration by Craig Gottwals – Attorney & RBP Expert
Aggressive billing strategies, remaining out-of-network, exploiting payment disputes to maximize revenue. misuse of the No Surprises Act, with a handful of private equity-backed providers and “IDR middlemen” routinely exploiting the law’s Independent Dispute Resolution (IDR)……
Continue reading Health Care Prices Rise as Role of Private Equity Grows
By Josh Butler, President, Butler Benefits & Consulting
I’ve been asked alot lately, “On High Plains Health Plan, do you work with other brokers?”
Continue reading Butler Benefits Offers Texas Brokerage Opportunity
A True Story By Bill Rusteberg
Rarely have we seen documented evidence like this of a practice long held secret within our industry.
Continue reading TPA Attempts To Steal Money From Plan Sponsor
TPA’s cannot convert revenue-code-only bills to Medicare yet they do. How in the world do they do that?
Continue reading How Do Reference Based Pricing Plans Reprice To Medicare When They Can’t?
“This consent order more consequential than almost any reg or law to be considered in the last 5 years!”
Continue reading FTC Consent Order Forces Structural Rewrite of How PBMs Operate
“It’s remarkable how they’ve managed to perpetuate the narrative of “losing” money on Medicare. Have to hand it to their PR/marketing departments & lobbying arms for pulling that off.” – Dave Chase
Continue reading Hospitals Blame Medicare To Justify Gouging Commercial Payers
Hospital Administrator Reacts
Stunning report that surprises no one concludes Reference Based Pricing will save government funded health plans a butt load of money. Who would have thought?
Continue reading Committee For Responsible Government Budget Spotlights Huge Reference Based Pricing Savings
By Spencer Smith
For employers looking to escape the volatility of stop-loss lasers and massive renewals, The Samaritan Fund Program offers a unique path forward.
Continue reading Escape The Volatility of Stop Loss Lasers – The Hot Potato Method
By Wiley Long
Most won’t surprise you. But #4 will change how you think about employee benefits. The evidence is overwhelming.
Continue reading 5 Reasons Businesses Are Abandoning Traditional Health Insurance
By Eric Bricker, M.D.
‘Payer Mix’ is the proportion of patients w/ each category of health insurance.
Continue reading Revenue Cycle Management: Payer Mix Explained
“If I were Atilla the Hun not for profit hospital CEO looking to control an entire universe and make a gazillion bucks along the way, I would…………”
Continue reading Aldeen’s Sunday Morning Bathroom Read – Attila The Hun Addition
Patients are being hit with this surprise fee just for seeing their doc
Patients who visit hospital-owned doctors’ offices are discovering something that could make them feel sick to their stomach: a surprise “facility fee” unrelated to the medical treatment they receive.
Continue reading $2,418 Hospital Facility Fee For A $93.40 Cortisone Shot
“It’s not our fault!” said the TPA, “The dog ate our homework!”
Continue reading TPA’s Response To Poor Performance