The Grand Healthcare Price Illusion

By Craig Gottwals – Mar 31, 2026

Most people assume that when a massive insurance company negotiates with a doctor, there is a single, disciplined price for a routine visit. We like to think that these billion-dollar entities use their size to ensure every patient gets a fair, standardized deal. The data recently shared by Josh Nakka and his team at PriceMedic proves that this is simply an illusion.

Jesse “Jay” Beck’s Texas Road Show

Our upcoming roadshow is an opportunity to connect in person, strengthen relationships, and share where we’re headed with our 2.0 initiative.

Attention P&C Brokers

We are an insurance intermediary

Avoid the delays and headaches associated with typical brokering arrangements and gain direct platform access through our program. We provide a unique opportunity for agents of any size to access primary markets that would otherwise be out of reach. Our function is to assist independent agents in the growth of their business without a partnership or merger of their enterprise. Our unique operation helps our affiliated agents stand out above the crowd.

ACE – A Unique Alternative In The Texas Marketplace

As a physician owned and operated entity, ACE provides a unique alternative in the Texas marketplace. We are focused on actively engaging with and managing the health of our members through our unique care coordination approach, optimizing care delivery.

Will Roger Survive Palace Coup Attempt?

Brownsville ISD To Consider Status of District’s Insurance Consultant

The Brownsville Independent School District is scheduled to consider the status the district’s insurance consultant during their April 7, 2026 board meeting.

Largest Public Sector Brokerage In Indiana

Apex has held the endorsement of the Association of Indiana Counties since 2006 and serves more public sector clients than any other Indiana advisory firm to this day.

How Aggressive Should Government Price Regulation Be?

According to this article efforts to lower commercial health care prices through government price fixing will:

Lead to lower quality health care
Reduce local employment
Cause hospital closures

No one, particularly politicians, wants lower quality health care, reduced local employment and hospital closures. So what’s the solution to solving an unsustainable system that’s bankrupting the American middle class?

State Laws to Lower Costs through Reference-Based Pricing

SOURCE: State Successes Passing Laws to Lower Costs through Reference-Based Pricing (FINAL, March 2026)

As of March 2026, 13 states have implemented reference-based pricing……..and underscores the increasing interest by states to lower health care costs

More Employers Are Directly Partnering With Healthcare Providers

SOURCE: Brighton HPS

In an effort to contain healthcare costs, many employers are creating health plans based on health systems, or hospital systems, near where their employees live and work.

23.1 Million Enroll on Free, Or Near Free Health Insurance Using Other People’s Money

Federal Open Enrollment Flyer

Nearly half of enrollees (46%) had household incomes between 100-150% of the federal poverty level with the vast majority receiving financial assistance. This highlights the program’s role in expanding access to affordable coverage for those who need it most.

Galena Park ISD Seeks Property & Windstorm Coverage

Date: April 14, 2026 before 2pm CST

The Galena Park Independent School District seeks responses to Request for Proposals #T01725 Property & Windstorm Coverage.

Express Scripts Just Got Sued for Racketeering. Here’s What That Means

Plaintiffs say a shadowy offshore entity helped Cigna and its PBM quietly siphon money meant for employers, unions and patients.

By Wendell Potter

A powerhouse law firm has filed a class action lawsuit that should make everyone who pays for prescription drugs through an employer or union health plan sit up and take notice. The target: Express Scripts, the nation’s largest pharmacy benefit manager — and its parent company, Cigna, where I used to work.

Houston Hospital Field Manual For RBP Plans

Sun Tzu

Choosing The Right Battlefield

The Houston medical industrial complex is a fortress built on BUCA market dominance. Reference Based Pricing infidels foraging for hospital encounters must understand the market and the extent to which hospitals will grant entry within their walls if at all.

TPA Opportunity

RiskManagers.us is searching for a Third Party Administrator with experience in Reference Based Pricing, Cash-pay / Direct contracting and care navigation support services for employer sponsored health plans in Texas

Southern Premier Administrators

Southern Premier Administrators is a third-party administrator (TPA) based in Austin, Texas, specializing in employee benefits administration and health plan management. The company partners with employers, brokers, and healthcare providers to deliver customized plan solutions and claims management services across the southern United States.

Ready To Quit Yet?

You built the business. Now let’s work on your legacy.

The Price Dropped But Yours Didn’t

“We do not expect the reduction in list price to impact net price.”

So……….What Else Is New?

Express Scripts Targeted By Racketeering Class Action

The PBM is accused of enriching itself through a fraudulent kickback scheme while its customers missed out on billions of dollars in drug rebates.

Excepted Benefit HRAs: An Introduction

March 27, 2026 – By: HUB’s EB Compliance Team – SOURCE: HUB International

An Excepted Benefit HRA (EBHRA) is an employer-funded health reimbursement arrangement that allows employers to reimburse employees, on a tax-free basis, for certain out-of-pocket medical expenses and premiums for excepted benefit coverage. Established under the 2019 tri-agency final rules, EBHRAs have been available for plan years beginning on or after January 1, 2020.

The Curative Mobile App Is Here

Give your employees an easier way to manage their care

Beyond the Network: Mastering the Cash-Pay Healthcare Model

There’s a reason more brokers are moving beyond PPO networks.

USPS Postmark Changes Could Affect Employee Benefit Plans

March 24, 2026 – SOURCE: Mercer

Employee benefit plan sponsors and administrators should be aware of changes to the United States Post Office (USPS) postmark process that could affect when government filings and participant disclosures are considered to have been sent on time.

Group HealthUnderwriting Solutions

With Gradient AI, insurers enhance their underwriting capabilities by gaining a more complete, in-depth picture of risk.

School Finance Annual Conference – South Padre Island, Texas

Property Casualty 360

Reference Based Pricing

By Robert M.

March 24, 2026

Reference-based pricing has a reputation for being disruptive. Providers push back. Employees get nervous. HR professionals hear the term and brace for a fight.

The New Era Of Cash Pay In Healthcare

“We are in a $5 trillion US healthcare consumer market with no consumer in it… I basically decided we had been surgically removed from the US healthcare system.”

Nationwide Group Health

Offer your clients more from a carrier your clients already know and trust.

Need Risk Management Assistance But Don’t Have The Time To Do A RFP?

Don’t have time to do a RFP? No problem, Region 14 has already done that for you.

How Do We Pay For A Single Payer System When We’re Broke?

The U.S. government is insolvent. That’s not hyperbole — it’s the conclusion drawn directly from the Treasury Department’s own consolidated financial statements for fiscal year 2025, released last week to near-total media silence.

Commercial Truck Insurance

Compare Top-Tier Plans Starting From $69.95/Month!

Join OMNIA Partners and Unlock Smarter Purchasing With OPUS

One platform. Millions of products. Zero cost.

OMNIA Partners is the nation’s most experienced cooperative purchasing organization, connecting public agencies to trusted suppliers.

Same Day Doctor Appointment

Beats a Poke In The Eye…………..

Brownsville Independent School District Seeks TPA Services

Texas Risk Pool Seeks Health Insurance Consultant / Plan Manager

Established in 1999 the South Texas Health Cooperative (STHC), a self-insured risk pool for Texas public school districts, is seeking a health insurance consultant / plan manager.

Aldeen’s Sunday Morning Bathroom Read – “Shark Tank Edition”

How a Texas couple is getting rich off out-of-network medical bills.

Benefits Cooperatives

A larger risk pool helps generate more competitive premiums and offers stability with longer rate guarantees.

Does Your Health and Welfare Plan Need a Committee?

By Katrina Veldkamp – SOURCE: Boutwell Fay

As employer-sponsored health and welfare plans grow more complex, transparency rules abound, new health and welfare plan fee disclosure rules take effect, and class action lawsuits increase (see our recent blog posts regarding voluntary benefits litigation and tobacco cessation program litigation), the need for structured oversight becomes critical. While ERISA doesn’t mandate fiduciary committees for these plans, forming one may be a smart move for plan sponsors.

Medicare For All Is Only One Election Away

All it takes is removal of the 65-year waiting period

The Real Reason Consultants Are Hired

Most of the time, you don’t hire consultants for insight. You hire them to borrow courage you refuse to grow.

Developing a Computable Payer-Provider Contract

“With over 1,000 health insurance carriers offering 318,000 distinct health plan products in the U.S. market………..Each carrier develops its own contract terms such as payment schedules, documentation standards, and prior authorization processes. They can market multiple types of products, HMOs, PPOs, high-deductible health plans, and each plan can have their own set of in-network providers. The complexity of this process contributes to the high billing-related costs in the U.S. market.“

Your Health Plan Has an AI Problem You Don’t Know About

A growing number of employers have restructured their health benefits around independent third-party administrators and reference-based pricing. These models decouple reimbursement from hospital chargemaster rates, effectively removing the mechanism AI billing tools exploit.

Fannie and Freddie Ease Insurance Rules

Lower insurance costs give new homebuyers more confidence they can afford a mortgage

Medicare Premiums Could Double Over The Next Decade, Wrecking Retirement Budgets

“Medicare is a Premium Paying Policy that eventually morphs into a Claim Paying Policy. If you die first you can’t collect later.” – Bill Rusteberg

Aetna $117+ Million False Claims Act Settlement Warning To ERISA Plan Sponsors & Fiduciaries

SOURCE: slphrbenefitsupdate.com

“These and other payer-focused investigations, prosecutions and settlements alert employer and union sponsored health plans, their sponsors and fiduciaries of the advisability of using prudent processes to verify the compliance of their health insurance vendors or the accuracy of their charges or other data to comply with the Employee Retirement Income Security Act (“ERISA”) and protect themselves and their plans from other avoidable costs and liabilities.”

The Risks of Level-Funded Health Plans

This article provides more reasons why employers want out of the health insurance business – RiskManagers

UnitedHealthcare Outperforms Market Benchmarks in Total Cost of Care

New third-party analysis finds that UnitedHealthcare delivered a more than 11% lower total cost of care compared to national benchmarks.

Compare Malpractice Tail Coverage Carriers in Your State & Save $1,000s

SOURCE: Malpractice Tail Coverage

Optional Extended Reporting Period Coverage, more commonly known as Malpractice Insurance Tail Coverage, is an insurance product purchased so that liability coverage extends beyond the end of the policy period of your claims-made medical malpractice insurance coverage.

Two Hospital Town Competes For Reference Based Pricing Business

This is what happens when Reference Based Pricing gains market share in a geographic area like the Lower Rio Grande Valley.

Imagine! Killing Two Birds With One Stone Event

Det. Quinn Says “Every Day Is St. Patrick’s Day!

Detective Quinn says “Every day is St. Patrick’s Day!“

Strait of Hormuz Standoff Puts Supply of America’s Generic Drug Prescriptions At Risk

By Kevin Williams

Nearly half of U.S. generic prescriptions originate in India, which relies on the Strait of Hormuz for the arrival of key inputs in drug manufacturing including petroleum-based materials, and for shipping finished medicines to the U.S.
People should not be worried about their medications yet, including high-volume ones for diabetes and hypertension, statins and antibiotics, as most medical distributors keep a 30- to 60-day supply on hand to withstand disruptions.
President Donald Trump is pressing other nations including NATO allies and China to help protect ships using the vital global marine traffic route. The risks from higher oil prices, and potential for drug shortages and delays, get more real every day.

Primary Care Doctors Struggle To Make Ends Meet

9 Problems Plan Sponsors Have With Their PBMs

By Bryce “Dick” Platt

Maritime Insurers Cancel War Risk Cover in Gulf as Iran Conflict Disrupts Shipping

“Freight rates are volatile amid the fresh instability in the Middle East, with most tankers now avoiding the strait of Hormuz as attacks and insurance cancellations make the area increasingly unsafe.”

Insurance rates could go up by 50% to 100%, or even more, from 0.25% to 0.5% or 1% of the value of the insured asset……………….terminal container rates for Shanghai to Jebel Ali in Dubai, the largest port in the Middle East, rose from $1,800 for a 40ft container on Saturday to about $3,700 on Monday, according to the online shipping marketplace

Yes, You Can Save 35% or More When You Buy Healthcare Direct (i.e. not through an insurance network)

By Dean Jargo

That’s the financial benefit to employer health plan sponsors. Now let’s review all the benefits for patients (your employees and dependents).

San Antonio TPA Simplifies HR Processes

Your Complete Benefits Administration Partner

Creative Benefit Administrators provides comprehensive third-party administration services, managing your employee benefits with expertise and innovation.

Eli Lilly Bypasses PBMs – Wants to Incentivize More Employers to Cover GLP-1s

Lilly will offer Zepbound, an injectable GLP-1 medication, at a price of $449 per month through a platform called Lilly Connect.

Balance Billing & Provider Push Back

Adam Russo of the Phia Group explains balance billing strategies

Benchmarking Claims Off Medicaid Fee Schedule

By Bill Rusteberg

There’s more than one way to skin a cat……………..

Reference Based Pricing plans typically benchmark claims against the Medicare fee schedule. Why not benchmark off the Medicaid fee schedule too?

Actuarial Warfare: How Seven Insurance Letters Closed the World’s Most Critical Chokepoint and Why Markets Are Mispricing Duration by 300%

London treaty reinsurers, confronting unlimited tail coverage, pull capacity………….

Allied National’s Solution For Tight Budgeted Employers Seeking Relief From Punishing Govt. Mandates

A Dental Plan That Beats A Poke In The Eye

Brownsville ISD Considers Early Termination of TPA Agreement

By Molly Mulebriar

The Brownsville ISD has a history of suing their TPA going back years. Pilot Life Insurance Company, Group & Pension Administrators, HealthSmart………….Will United HealthCare be next?

The Growth of Claims Audits

Written by Tim Rieger, Vice President, Sales, Consulting & Education

A growing trend among self-funded medical plans is the increased focus on claims audits. Unlike dependent audits, claims audits are more comprehensive and time-consuming. Employers are increasingly recognizing their fiduciary duty to act in their employees’ best interests, making claims audits an essential part of meeting these responsibilities.

5 Best Workers Compensation Insurance (2026)

SOURCE: Best Business Insurance Companies of 2026

Compare the leading workers compensation insurance providers and agencies of 2026. We reviewed and ranked based on ease of the policy purchasing process, industry accreditations, customer service capabilities, and past customer reviews.

A Common and Costly Oversight: The Importance of a Written Section 125 Plan

A Common and Costly Oversight: The Importance of a Written Section 125 Plan

The Price of Babyhood In Carizzo Springs, Texas

SOURCE: Dimmit Regional Hospital

Blue Cross believes babies are worth more while United HealthCare believes they’re worth less and mothers don’t care because their babies are priceless………….

The Story Behind ‘Lunch Atop A Skyscraper

“Lunch Atop A Skyscraper” captured 11 workers lunching amid construction of New York’s Rockefeller Center on September 20, 1932 — but there’s much more to the story.

For nearly a century, the iconic photograph “Lunch Atop A Skyscraper” has been uniquely evocative of everything from New York City to the Great Depression to America itself. The photo features 11 construction workers casually having lunch while dangling 850 feet above the Big Apple one September day in 1932. But while its imagery is legendary, few know the remarkable story behind it.

Sturgis, Michigan Has 10,000 Residents

By Dutch Rojas – Visit my website

Sturgis, Michigan has 10,000 residents. One company based there billed $826 million in Medicaid personal care services between 2018 and 2024.

For context: to bill $826 million in 15-minute increments at Medicaid rates, you would need to document and submit claims for a number of service hours that, divided by the local population, implies every man, woman, and child in Sturgis received personal care assistance for roughly 2.3 hours per day, every day, for six years.

Texas Penal Code §32.45 — Misapplication of Fiduciary Property

A person commits an offense if he intentionally, knowingly, or recklessly misapplies property he holds as a fiduciary or property of a financial institution in a manner that involves substantial risk of loss to the owner of the property or to a person for whose benefit the property is held.

Aldeen’s Sunday Morning Bathroom Read – The Oregan Potato Company Caper

“The Oregon Potato Company Caper exposes, once again, the nasty underworld of health insurance brokerage” – Bill Rusteberg

GoodRx to Expand Employer-Sponsored Access to Zepbound® KwikPen®

SOURCE: GoodRx – Mar. 6, 2026

GoodRx Employer Direct enables self-insured employers to subsidize the $449 Lilly Employer Connect medication price for Zepbound KwikPen to reduce employee out-of-pocket costs

Hospital Financial Statements, Clinical, and Quality Metrics

Analyze financial statements and clinical metrics of every hospital in the U.S. Review balance sheets, debts and ratios, cost centers, and other financial data. Look up hospital inpatient surgeries, ER visits, average daily censuses, total acute days, and other clinical information.

Health Insurance Costs by U.S. State in 2026

Health insurance costs are rising across the United States in 2026, as enhanced Affordable Care Act (ACA) subsidies expire and insurers raise premiums to keep up with higher healthcare costs.

This graphic shows the average health insurance cost on the ACA marketplace in 2026, based on data from ValuePenguin.