Archive for the ‘Uncategorized’ Category

Why Can’t I Get A Total Price On My Healthcare Procedure Before I Go?

Tuesday, June 18th, 2019

Thomas Farmer

“It looks like we are entering the “shipping & handling” awareness phase of healthcare costs.”

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Was J Patrick Rooney Right?

Monday, June 17th, 2019

Purveyors of Reference Based Pricing strategies can’t seem to agree on what the reference benchmark should be. Thirteen years ago J. Patrick Rooney (1927-2008) said it was 125% of Medicare. Was he right?

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Dendy Opines on North Carolina RBP Fiasco

Monday, June 17th, 2019

The state of North Carolina has received considerable push back from the medical community in their efforts to reign in rising health care costs for public employees. Scheduled to implement Reference Based Pricing strategies beginning January 1, 2020, the state’s medical industry (primarily hospitals) have pushed back so hard there is now doubt the plan will ever take effect. 

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 John W. Sbrocco

Friday, June 14th, 2019
John W. Sbrocco, CSFS
Healthcare Consultant helping self-funded employers evacuate & reduce medical claims.

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Sharing Plans Gaining Market Traction

Friday, June 14th, 2019

Sharing plans are not new. They have been around for years. While not insurance, these programs can offer affordable access to health care.

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Hungry? Free Lunch in San Antonio June 19!

Thursday, June 13th, 2019

HealthComp Hosts “Lunch & Learn” with H-E-B and Baptist Integrated Health Partners in San Antonio

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Will Judge Demand Marriage Annulment?

Wednesday, June 12th, 2019

Some marriages are just not meant to be…………………..

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Medicare-For-All Gaining Support Among Businesses?

Monday, June 10th, 2019

“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction………”

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The Best Discounts In Health Care Are Not Through Your Health Insurance Company

Saturday, June 8th, 2019

 

 “How Much Did You Say That Xray’s Gonna Cost?

A little ole housewife with cash in her purse has more bargaining power than Blue Cross, United HealthCare and Aetna combined………………………

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San Antonio Flu Epidemic Season Is Winter, Spring, Summer & Autumn

Friday, June 7th, 2019

It pays to be sick in San Antonio and Dallas these days………………………

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Recent Trends in Stop Loss Claims

Friday, June 7th, 2019

SOURCE: Frenkel Benefits

“The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims.

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Survey Reveals “Me Too” Brokers In The Majority

Thursday, June 6th, 2019

“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”

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One Election Away From Free Single Payer System

Wednesday, June 5th, 2019
Successful pandering to gain voters is best achieved by promising free stuff. Each national election we end up getting more free stuff. And we haven’t yet run out of other people’s money…..Hallelujah!

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If We Don’t Fix Health Care Big Government Will

Wednesday, June 5th, 2019

There has not been a competitive health care market for years. Managed care contracts have contributed to that. Some employers have fixed health care buy most haven’t. This blog has written about the former in the past so if you are a regular reader you know exactly what we are talking about.

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2020 HSA and ACA NGFP Limits

Tuesday, June 4th, 2019

Government control of health care (a precursor to a single payer system) continues to manifest itself with constant dictates from bureaucrats in Washington. . The newest and latest message from the swamp is “we’ve placed a new limit on what you can save tax free towards your personal healthcare……………….” Our in-box receives numerous daily updates like the one below:

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Health Care Financing 101

Monday, June 3rd, 2019

Massachusetts hospitals stash $1,600,000,000 in offshore accounts…………….

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MediBid is Pleased to Announce Its New Medicare Allowable Lookup

Sunday, June 2nd, 2019

                  Ralph Weber 

Ralph says bundled health care pre-negotiated cash pricing comes in at an average of 108% of the Medicare rate.  That’s a very good number in case you’re wondering………………. 

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Trump Ready To Force Transparency In Healthcare Pricing With An Executive Order

Thursday, May 30th, 2019

Transparency in health care pricing doesn’t make a whole lot of sense when it’s other people’s money paying for all of this. Who cares what the cost is when all you have to pay is a small co-pay, or some sort of deductible. Then, when you enter that Magical Kingdom called Maximum-Out-Of-Pocket Limit you tend to go crazy in getting more health care to (1) milk it for all it’s worth and (2) revenge against the evil insurance carrier that makes you pay so much in co-pays and deductibles while charging you an arm and a leg in insurance premiums.

Health care pricing transparency does makes sense when Reference Based Pricing strategies are employed. “My plan will pay you $500 for that procedure, so how much will you charge me? Oh, never mind, I think I can find someone else that will do it for $500………………………

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California – Free Health Insurance For Planet Inhabitants

Thursday, May 30th, 2019

If you live anywhere on this planet and need free health insurance that covers pre-existing conditions without any waiting period what so ever, come quickly to California now! No passport needed nor pesky immigration hurdles to jump through. Just cross the border at any point of your choosing, turn yourself in and get a free airplane or bus ticket to the Golden State.

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Hospitals Foster Lonely Hearts Club Memberships

Wednesday, May 29th, 2019

“If you are isolated and lonely, but you have someone that you remember, like nurse April, nurse Tina, or nurse John, and they’re like, ‘Hey, how are you doing?’ And you’re greeted with warmth and love, well yeah, I’m gonna come back”………………Three (lonely) patients visited the hospital 500 times in one year………………..

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The Cost of Convenience

Monday, May 27th, 2019

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

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Hospitals Dismiss Significance Of Chargemaster Prices?

Monday, May 27th, 2019

Victor Lustig

“Percentage of savings fees is the greatest fraud foisted upon consumers since Victor Lustig sold the Eiffel Tower in 1925.  To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.”

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Are Carriers and PPO Networks Slowly Becoming Obsolete?

Sunday, May 26th, 2019
PPO networks do not offer the savings they were designed for when first introduced to the market over 25 years ago………..The days of the PPO and HMO networks are slowly becoming as obsolete as the rotary phone, because the current system is just not working…………….Reference Based Pricing is going to become the new norm, providing competition in the marketplace and controlling costs……...

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McAllen ISD Invites 212 Vendors To Submit Bids – Chaos & Madness

Saturday, May 25th, 2019

Insurance Brokers Fight For Markets

We received notice / invitation to bid from the McAllen Independent School District along with 211 other vendors shown as email recipients. The brokers among them will be stumbling all over themselves to get quotes from the same four or five markets……………………This is exactly why smart brokers stay away from public RFP’s…………….

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Blue Cross Joins The Doctors Practice Party

Saturday, May 25th, 2019

“In 2018, Blue Cross members seen at South Florida Sanitas clinics—which opened in late 2015—had 32 percent fewer inpatient admissions, 34 percent fewer outpatient visits and 20 percent fewer emergency room visits compared with members who went to nonaffiliated clinics.”

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New Drug Will Bankrupt Your Plan by $2,100,000.00

Saturday, May 25th, 2019

At $2.1 million, newly approved Novartis gene therapy will be world’s most expensive drug

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A Status Quo Broker’s Worst Nightmare Just Happened In D.C.

Friday, May 24th, 2019

Status Quo Health Insurance brokers are in for a lot of explaining to do. “Mr. Employer, I’m receiving $340,000 more than the $124,000 I’ve disclosed to you in the past. Plus, if I convince you to renew with your current carrier, I get an additional $25,000 renewal bonus! You OK with that? “

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Memorial Day 2019

Thursday, May 23rd, 2019

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. 

The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.

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Working Smart – It’s All About Destroying Relationships

Thursday, May 23rd, 2019

By Charles Specht

I love this stuff! Targeting signed Broker of Record Letters makes so much more sense than blindly quoting policy renewals, throwing mud against the wall to see what sticks, and “hoping for the best.”

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Health Sharing Plans

Thursday, May 23rd, 2019

By Bill Rusteberg

Health share plans are growing in popularity these days. Cost is significantly lower than insurance plans as you will see by clicking the link below. However beware these plans are not insurance and there is no guarantee claims will be paid/covered.

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Hidden Fees

Tuesday, May 21st, 2019

By Bill Rusteberg

Hidden fees in health care delivery earned by third party intermediaries can be significant.

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‘Sham’ Sharing Ministries Test Faith Of Patients And Insurance Regulators

Tuesday, May 21st, 2019

Texas insurance officials have scheduled a hearing to consider a similar order against Aliera, which has 100,000 members nationwide and reported revenue of $180 million in 2018, documents showed……

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Why Employers Are Getting Screwed In Health Care Pricing

Tuesday, May 21st, 2019

“As recently as 2000, private payers were paying only 10% more than Medicare. Since then, the gap has been growing by leaps and bounds.” That has since grown to 200-300% and as much as 400%……….

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PPOs and the $444 Box of Kleenex

Thursday, May 16th, 2019

Healthcare providers set astronomical, arbitrary prices, and employers and insurers have few options. But a solution is emerging. 

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Texas School District Challenges TRS ActiveCare Plan Mandates

Wednesday, May 15th, 2019

Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, the Raymondville Independent School District in deep South Texas has decided to act.

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More TRS ActiveCare Angst Among School Administrators

Monday, May 13th, 2019

Local school districts voice concern over rising costs for health coverage

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Another State Adopts Reference Based Pricing

Monday, May 13th, 2019

“To attract providers, Washington lawmakers chose a relatively high figure to start: The plan caps payouts at 160 per cent of federal Medicare rates……..”

Plan is expected to be competitive “in part to savings from a cap on rates paid to providers……………..”

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TRS Strategy To Control Health Care Costs Screws Plan Members

Sunday, May 12th, 2019

The following article reports that “TRS trustees noted the only tools available to them to address rising costs each year are to”:

  1. increase premiums
  2. lower benefits
  3. or a combination of both

Really?

Meanwhile, smart plan sponsors have solved the rising cost of health care in Texas and it ain’t by increasing premiums and lowering benefits. Rather, it’s by lowering costs and improving benefits at the same time……sounds crazy doesn’t it?

(The Texas legislature’s answer to addressing rising health care costs is House Bill 3987, that if passed, will authorize a committee to study the issue and report back in two years. But some Texas school districts are not waiting……..)

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Let The Sun Shine In…………………..

Saturday, May 11th, 2019

Health Plans Should Prepare For Plan Fallout Of HHS Rule Requiring Manufacturers Disclose Drug Prices

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El Paso ISD To Adopt Exemption To TRS ActiveCare Requirement

Saturday, May 11th, 2019

The El Paso Independent School District is set to adopt an exemption to Texas Education Code 22.004(i), which prohibits a District that has implemented employee group health coverage pursuant to Chapter 1579 of the Insurance Code (TRS ActiveCare) from providing any kind of alternative group health coverage at their May 14 board meeting.

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Too Damn HIgh!

Saturday, May 11th, 2019

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Fearless Agitator Rattles Cages For Fun

Friday, May 10th, 2019

The Real David in David & Goliath 

By David Contorno

Employers…..contrary to what you think, health insurance carriers make MORE revenue and profit as your health care costs go up. It’s federal law.

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Protection Money Scheme Dominates HealthCare

Wednesday, May 8th, 2019

Pssst…Godfather, Mulebriar Is At It Again!

“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see nor audit, violates fiduciary duties and is contrary to basic, common American business practices. “

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The Fallacy of PPO Re-Pricing Exercise

Wednesday, May 8th, 2019

Each time I see a Request for Proposals put out by insurance consultants requiring a PPO Re-Pricing Exercise in an effort to determine which network has the best discounts the temptation to reach out to Jose Cuervo is tough to ignore. 

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Who’s The Dick That’s Going To Explain Our Healthcare Tragedy?

Tuesday, May 7th, 2019

If you’re an insurance company, the simplest way to make more money, is to PAY MORE for medical services. In fact, provider negotiations should go like this:

Doctor: I want $100 for this procedure.

Insurance Company: No, we won’t pay you a penny less than $250. 

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Hospitals Are Committing Financial Suicide But Don’t Know It

Monday, May 6th, 2019

Hospitals have overplayed their hand. Galeforce blowback has arrived.

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Size Means Nothing in Health Care Financing – Common Sense Does

Sunday, May 5th, 2019

This is what a +400,000 life group plan offering status quo healthcare strategies gets you these days…………

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Reference Based Pricing Blitzkreig

Friday, May 3rd, 2019

“For-profit hospitals charge 700% more than Medicare prices, while non-profit hospitals charge 550% more. Traditional PPO plans offering a 50% discount may end up paying 300% more than the Medicare price”.  In Texas where Reference Based Pricing strategies have been around since 2007, plan sponsors are paying between 120% to 150% of Medicare…………………….The Reference Based Pricing Blitzkreig is gaining market share quickly……………

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Astute Purchasing Agent Nails It

Friday, May 3rd, 2019

A long time friend who has spent almost all of his working life in the pubic purchasing arena in Texas has a perspective that many of us in the insurance community have failed to acknowledge. 

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Grandpaw-hood At Risk?

Thursday, May 2nd, 2019

 “Please don’t leave us Grandpaw!!!”

Hey Grandpaw, I’m thinking of giving my children (your grandchildren) a few free gifts this year but I may decide later to take them back. But………. I’m worried the government will require you to disown us under penalty of sanctions!

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Shoddy Health Care, Missed Diagnosis, Unnecessary Treatment……….

Tuesday, April 30th, 2019

Diagnosed with the “Big C?” At least 10% beat it because they didn’t have cancer in the first place……...

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Judge Recuses Self Over Views On Insurer’s ‘Barbaric’ Policy

Tuesday, April 30th, 2019

UHC Company Executives?

A Florida federal judge stepped down Monday from a proposed class action claiming UnitedHealthcare improperly classified a certain cancer treatment as experimental to avoid providing coverage, saying his personal opinion prevented him from ruling fairly on what he called “immoral and barbaric” actions.

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Is Your Employer Worksite Medical Clinic a Group Health Plan?

Monday, April 29th, 2019

“An employer maintaining a workplace clinic (or considering one) needs to understand the group health plan compliance risks and the general risks associated with doing so and take reasonable steps to mitigate those risks.

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Medicare For All Already Exists

Monday, April 29th, 2019

We have Medicare for all already………………………………………..

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States Look To Medicare-Based Reference Pricing Strategies

Thursday, April 25th, 2019

Meanwhile, back at the ranch, the Texas legislature kicks the can down the road……………..again.

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The Future of Personalized Medicine is Here

Thursday, April 25th, 2019

One simple test, we can improve quality of life and save healthcare resources……………..

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Power Struggle in Dallas

Thursday, April 25th, 2019

Blue Cross Blue Shield of Texas removes 14 DFW hospital emergency rooms with out-of-network docs from network………………….

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A New Kind of Pharmacy

Thursday, April 25th, 2019

Blue Cross To Offer $10 Co-pay Food Plan

Thursday, April 25th, 2019

Will food program drive down health care costs in Chicago and Dallas?  A portion of your BCBS premium dollars will be allocated to find out……………

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Need Surgery? Go On-Line and Book It

Wednesday, April 24th, 2019

Imagine if you need some sort of surgical procedure like a knee replacement. Simply go on-line and book it. Your employer has arranged to pay the providers you select  prior to services rendered, including all or a part of your share of the cost. It’s that easy.

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Texas House Bill 3933 – A Panacea for Reference Based Pricing Plans?

Tuesday, April 23rd, 2019
The Texas legislature is considering numerous bills of interest to those of us engaged with health care delivery in this state. HB 3933 is one, that if passed, will have a considerable impact upon the health care community.

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Webb County Seeks P&C Insurance Consultant

Tuesday, April 23rd, 2019

RFQ 2019-0006 Package for a Consultant for Health Insurance for Webb County can be obtained from our EBid site located at:  https://webbcountyebid.ionwave.net/CurrentSourcingEvents.aspx

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PBM’s

Tuesday, April 23rd, 2019

Going Broke? Never Mind, Just Print More Money

Monday, April 22nd, 2019

Trustees project Medicare trust fund will be depleted in seven years………..So let’s do Medicare For All and see if we can go broke faster……………………………Never mind. Sam, fire up the ole printing press will ya………..we’ed be needing some money to pay for all this.

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Disruptive Digital Business Models For Health Insurers

Monday, April 22nd, 2019

“The main impact of digital business models is on company evaluation, which reflects the hype that some companies have created in the investor community. Companies like Oscar, Clover Health, and Bright Health are valued at over $1 billion USD each after only a few years of operation.”

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Texas Considers Balance Billing Legislation For Self-Funded Plans

Sunday, April 21st, 2019

At first glance Texas Senate Bill 1530 looks appealing. Balance billing protection for self-funded health & welfare plans would be a welcomed gift from government, especially among purveyors of Reference Based Pricing plans. 

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33% of U.S. Workforce Using Prescription Pain Medications

Thursday, April 18th, 2019

      Morning Shift Arriving At Work

One in three workers reported using prescription pain relievers — the majority under treatment of a physician………………………

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The Antithesis of Managed Care

Thursday, April 18th, 2019

Insurer Paid +300% of Medicare But The Discount Was Really Good

Thursday, April 18th, 2019

In the article by Marshall Allen that follows patient questions why Aetna paid  a grossly inflated rate of more than 300% of Medicare for his in-network claim. Well, that’s not the way Aetna or any other managed care company wants you to look at it. Instead they want you to focus on “discounts.” Managed care companies like Aetna reinforce that focus by sending patients EOB’s highlighting those amazing and magnificent discounts applied against billed charges. Could it be you may be looking at a 50% discount off double the price?

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Health Insurance Hustle

Thursday, April 18th, 2019

Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose

The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.

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The Death of PPO’s

Wednesday, April 17th, 2019

PPO’s are a fraud and more are beginning to understand that. The only thing PPO’s can guarantee is the promise of no balance billing. That’s a powerful and effective coercive method used to foster obedience to status quo strategies of the past 35 years.  However, the truth is we are all running out of money to fuel the American Healthcare Monster. Breaking away from status quo solutions will soon become a national epidemic towards fundamental change bringing sanity to health care costs in this country – Bill Rusteberg.

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Reason & Logic Won’t Move TRS ActiveCare Trustees

Tuesday, April 16th, 2019
TRS ActiveCare Plan Manager Struggles To Save Program
“It’s impossible to prove something to someone whose salary depends on believing the opposite” – Upton Sinclair

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Another Win For The Oklahoma Medical Association

Tuesday, April 16th, 2019

We’re excited to have a contract for services with the Texas Free Market Surgery Center. Our Texas clients who join the Oklahoma State Medical Association (OSMA) health plan will now have access to bundled pricing in Austin, Texas.

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Fully Insured Dental Plan Request for Proposals

Monday, April 15th, 2019

McAllen Independent School District (the “District”) invites your submittal on: RFP No. 2018-200 – Fully Insured Dental Plan…………………….

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Adverse Selection Dooms TRS ActiveCare

Monday, April 15th, 2019

The TRS ActiveCare plan for Texas school districts is imploding. Many want out of the program…….

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