The following represents an offer to provide certain actuary services to self-funded health & welfare plans:
Continue reading The Affordable Care Act Highlights Need for Actuarial ServicesCategory: Uncategorized
State Of Montana Reopens Bids For State’s Reference Based Pricing Plan
The original RFP document said the state wanted bidders to show they could keep reimbursement levels below the current mark of 245% of Medicare rates, and as close as possible to 195%.
Continue reading State Of Montana Reopens Bids For State’s Reference Based Pricing PlanBCBS of Minnesota Sued Again, and Again, and Again……..
Paul Miller’s History of Lloyds Series
By Paul Miller, London
Did you know that Lloyd’s of London helped Mickey Mouse celebrate his 8th birthday?
Continue reading Paul Miller’s History of Lloyds SeriesBCBS Louisiana For Sale?
More Louisiana officials are voicing opposition to the planned sale of Blue Cross Blue Shield of Louisiana to Elevance Health.
Continue reading BCBS Louisiana For Sale?The Joy Associated With A Primary Care Visit Cannot Be Understated
To see a traditional fee-for-service doctor these days you may have to wait 1 month for an appointment or longer, and then wait an hour or more while sitting in the reception area along with sneezing, drooling, belching, coughing patients in order to see the doctor for 5, or if you’re lucky, 10 minutes.
Continue reading The Joy Associated With A Primary Care Visit Cannot Be UnderstatedHarbor Health
A better benefit design, built by Harbor Health
Later this year, Texas-based employers will be able to choose our all-new benefit design created to help self-funded groups eliminate cost barriers along the consumer health journey.
Continue reading Harbor HealthScrew Your PPO Discount – We Like This One Better
Want proof a 20% PPO discount off arbitrary billed charges is meaningless? Read on…..
Continue reading Screw Your PPO Discount – We Like This One BetterAtrium Health: A Unit of ‘Local Government’ Like No Other
“When it suited them, they could be a private nonprofit……….When it didn’t suit them, they could jump back into being a government entity — although there was no government involved.”
Continue reading Atrium Health: A Unit of ‘Local Government’ Like No OtherSan Antonio Independent School District Seeks Insurance Consultant
The San Antonio Independent School District (SAISD) requests interested parties to submit proposals for “Employee Benefits Consulting Services”. This award is contingent upon funding and no guarantee of a minimum amount of work is implied or expressed by this Request for Proposals. Services required shall be determined solely by the needs of the District.
San Antonio Independent School District – 24-006 (LC) Employee Benefits Consulting Services
Continue reading San Antonio Independent School District Seeks Insurance ConsultantYour Honor! ‘Motion To Kiss My Ass’
Article Referred By Doug Aldeen Which Somehow Has Something To Do With The American Healthcare Delivery System (although we don’t know what)
On April 5, 1996, this Court ordered Plaintiff to show cause why this Court should not impose Rule 11 sanctions upon him for filing a motion for improper purposes. The motion which Plaintiff filed was entitled “Motion to Kiss My Ass” (Doc. 107) in which he moved “all Americans at large and one corrupt Judge Smith [to] kiss my got [sic] damn ass………………………..”
Continue reading Your Honor! ‘Motion To Kiss My Ass’Marpai – Buy Low Sell High
Mr. Lamendola, as the Company’s largest shareholder, has committed to investing at least $3 million in equity during 2024.
‘Hospitals and Insurers Are Robbing Us’
Jelly Roll, Lainey Wilson, Valerie June Demand Healthcare Reforms: ‘Hospitals and Insurers Are Robbing Us’
The three artists called for pricing transparency in a PSA from Power to the Patients set to air during Super Bowl LVIII
Continue reading ‘Hospitals and Insurers Are Robbing Us’Buying & Selling Capacity
Green Imaging has been wildly successful in buying capacity for resale in the health care world of American health care finance.
Continue reading Buying & Selling CapacityThis Is Why Health Plans Fail
We are not picking on TSHBP – their program is not much different than any other employer sponsored plan of the past 40 years.
Continue reading This Is Why Health Plans FailAlabama Providers Claim BCBS Stiffed Them Out Of $5,000,000,000
The lawsuits alleged a conspiracy among Blue Cross and its members to curb competition, driving up the cost of insurance and driving down reimbursements.
Continue reading Alabama Providers Claim BCBS Stiffed Them Out Of $5,000,000,000The Crazy World Of American Rx Financing
More plan sponsors are saying ENOUGH IS ENOUGH ALREADY! Eliminating brand name and specialty drugs completely, leaving over 12,000 FDA approved generic drugs is an option more plans are considering.
Continue reading The Crazy World Of American Rx FinancingOne Company Cut Health Spending by Nearly Half: A Case Study
“It was rough in the beginning because we all get this programmed in our head that magic insurance is gonna pay for everything and we have no responsibility…..”
Continue reading One Company Cut Health Spending by Nearly Half: A Case Study4,000 Pound Gorilla Issues RFP For Consulting Services For Self-Funded Health Plan
Cano Health Bites The Dust
Article Referred By Alex Zuniga (One of our three readers)
A healthcare provider that recently left the South Texas market has failed to stem losses and is filing for bankruptcy.
Continue reading Cano Health Bites The DustYou Want How Much? You Get What You Pay For………….
“How Much Do You Charge?” asks the prospect, a large public school district spending $50,000,000 on their self-funded health plan………………
Continue reading You Want How Much? You Get What You Pay For………….Are You Next?
The Mysterious Case Of The Dallas ISD Off-site Clinic Partnership
No one willing to comment on whether the program still exists………..
Continue reading The Mysterious Case Of The Dallas ISD Off-site Clinic PartnershipThe BUCA Billions
By Julie Selesnick, Senior Counsel at Berger Montague
Seriously, all the handwringing over how complex our healthcare system is and why cost containment is so difficult is silly—the answers are pretty obvious.
Continue reading The BUCA BillionsAre You Next?
Recent Lawsuit Implies Thinking Outside The Network Box Is A Fiduciary Duty
By Kevin Weinstein – Chief Executive Officer at Renalogic
February 6, 2024
If you haven’t already, everyone involved with employer-sponsored healthcare should read and understand this lawsuit (Lewandowski v. Johnson and Johnson) filed by an employee against Johnson & Johnson’s health plan. The key allegation is that the J&J health plan failed in its fiduciary responsibility to design and oversee a health plan that benefits members and pays reasonable rates for services.
Continue reading Recent Lawsuit Implies Thinking Outside The Network Box Is A Fiduciary DutyArchie’s Hospital Admission
Archie admits himself to the hospital for his operation when he has a run-in with one of the nurses.
Continue reading Archie’s Hospital AdmissionEmployee Sues Employer Over Breach of Fiduciary Duties
“Here it is folks, the case everyone has been waiting for: an employer has been sued for breaches of their fiduciary duty under ERISA by a plan participant for the drug costs in their self-funded health plan.“
Continue reading Employee Sues Employer Over Breach of Fiduciary DutiesUS Beacon – Medical & Rx Cost Containment Review
US Beacon (USB) conducts compliance analysis review of medical claims for corporate and government health care and workers compensation plans.
Continue reading US Beacon – Medical & Rx Cost Containment ReviewPrisoner’s Dilemma – Game Theory in Health Plans
By Russell Pekala
Setup: Providers (red) make a choice “Play nice” or “Play dirty” represented by the left and right columns and receive RED payouts. Payers make the same choice represented by the top and bottom rows and receive BLACK payouts
Continue reading Prisoner’s Dilemma – Game Theory in Health PlansThe Parakoff Policy
Johnny Dollar, America’s fabulous freelance insurance investigator, investigates a murder involving a beautiful widow in a negligee……………..
Continue reading The Parakoff PolicyThe Curious Case Of ‘Free’ Covid-19 Tests
By Ge Bai – The Curious Case Of ‘Free’ Covid-19 Tests
Starting from November 20th, 2023, every household in the U.S. can order eight “free” at-home Covid-19 tests (four for those that already ordered this fall). How much taxpayers paid for these tests remains undisclosed.
Continue reading The Curious Case Of ‘Free’ Covid-19 TestsSunday Morning Bathroom Read (“Send Lawyers, Guns and Money” Edition)
By Doug Aldeen
The Great Aldeeni is on to something! – Open an Aldeen Miracle Grow Bank Account today and receive a bag of carrots and a free trip to Disney Land! – The H&R Block of IRC 501r? Take it public – The IPO has got to be a record breaker – Will the Great Aldeeni offer franchise opportunities? Count me in………..
“I would set up a booth in every grocery store across the US (much like H&R Block and its ubiquitous “tax refund” stands) and charge a flat fee to process the charity care application……….. “Honey, make sure to pick up a loaf of bread and while you are it, get our charity care application submitted. We should get back enough to take the entire family to Disney this year.” – Doug Aldeen
Continue reading Sunday Morning Bathroom Read (“Send Lawyers, Guns and Money” Edition)Is My Employer Group Health Insurance Better Than Medicare?
!If you’re getting ready to turn 65 but you’re on your spouse’s health insurance because he or she is still working, should you stay on his employer healthcare plan or get on Medicare?
Continue reading Is My Employer Group Health Insurance Better Than Medicare?The Never Ending La Joya ISD Shit Show Continues…..Episode # 54
Texas Education Agency takes over La Joya ISD after investigating school board for fraud and conflicts of interest…………..
Continue reading The Never Ending La Joya ISD Shit Show Continues…..Episode # 54Fire The Department of No, Hire The Department of Yes
Brokers/Consultants, pay particular attention to the last 2 minutes of this 13 minute video by Eric Bricker. He is absolutely dead on. Too many brokers don’t do this. Instead they waste time working through the Department of No (Human Resources).
Continue reading Fire The Department of No, Hire The Department of YesSimplePay Health
A Happier Way To Healthcare.
Welcome to SimplePay Health, – the alternative health plan that saves you money without sacrificing top-quality healthcare.
Continue reading SimplePay HealthWhat’s The Final Tally On What Could Be The Biggest Health Insurance Reinsurance Loss In History?
TSHBP: The Biggest Reinsurance Loss In Health Insurance History?
The 12/18 contract is over ending 31 December 2023. What are the underwriting losses? No one’s talking, the stop loss brokerage community is tight lipped. Rumors abound lawsuits are flying, attorneys are busy. Who knows the truth? No one is talking.
Continue reading What’s The Final Tally On What Could Be The Biggest Health Insurance Reinsurance Loss In History?Hospital Pricing Increases A Staggering 244% in 3 Years
By Justin Leader – Visit my website
The attached graph, sourced from the Bureau of Labor Statistics, reveals a worrying trend that should be a wake-up call for all plan sponsors. Between January 2000 and December 2023, hospital services experienced a staggering 243.7% increase in prices, significantly outstripping the overall inflation rate of 82.4% during the same period. This isn’t just an anomaly – it’s a red flag.
Continue reading Hospital Pricing Increases A Staggering 244% in 3 YearsAn Insurance Policy That Doesn’t Cover Anyone or Anything
A ghost policy is a minimum premium workers’ comp policy for a one-person business. However, the company owner is exempt from the policy, so it doesn’t actually cover anyone. You can expect an annual premium between $1,000 and $2,000.
Continue reading An Insurance Policy That Doesn’t Cover Anyone or AnythingWhen The Boss Promotes The Wrong People
I’ve seen this first hand years ago when I worked for a large health insurance company. A toxic little man with a big ego and a drive to get to the top over dead bodies drove away the best producers leaving only sedated order takers to make quota. Before their mediocre performance became overwhelming evident to upper management Little Napoleon moved on to another company securing a position of even greater responsibility and authority. He repeated the process, going from company to company until he could go no further as President of a BUCA. – Bill Rusteb
Continue reading When The Boss Promotes The Wrong PeopleEurope’s Largest Company Made Possible By Fat People
Novo Nordisk hits $500 billion in market value as it flags soaring demand for Wegovy, Ozempic
Continue reading Europe’s Largest Company Made Possible By Fat PeopleHealth Care Pricing Estimates Are Bullshit
SOURCE: Mitigate Partners, LLC | Employee Benefits Consulting
Somehow, hospitals and insurers continue to get away with only providing estimates and not actual prices for their services and procedures. This allows our healthcare system to remain rigged for their profit and to the detriment and demise of patients, families, communities, tax payers, unions, employers, and municipalities across the country.
Continue reading Health Care Pricing Estimates Are BullshitHow to Fix Rural Healthcare: LEAVE US ALONE.
“I left our CAH almost 8 years ago and started a Direct Primary Care clinic. It operates purely in the free-market economy and is thriving. Small regional hospitals are now coming around to my way of thinking and are now beginning to bundle things like radiology studies, and surgery, etc. to compete with each other for cash business, and it’s making them money and saving patients money. These hospitals have to find loopholes in the bureaucracy to do this (the government and the trillion-dollar insurance companies who control the elected officials in the shadows love the status quo and want prices to stay high).“
Continue reading How to Fix Rural Healthcare: LEAVE US ALONE.Gorillas, Chimpanzees & Monkeys
Which one are you, a gorilla, chimpanzee or monkey? And are you a cost containment disruptor? Don’t get too comfortable because your seat at the table is temporary…………..
Continue reading Gorillas, Chimpanzees & MonkeysDoctor Reacts To South Park Medical
While Cartman’s gingervitis might not be real, gingivitis is and there are tons of myths about red/ginger hair and freckles.
Continue reading Doctor Reacts To South Park MedicalAnonymous Hotline Tipster Saves American Healthcare Trillions
“It’s dinner on the East Coast in less than an hour and people are gonna die!…………Sir, we’ve got a boy on the Hot Line and he thinks he knows something……………!
Continue reading Anonymous Hotline Tipster Saves American Healthcare TrillionsHow Much of Total U.S. Health Spending Is Currently Funded By The Federal Government?
The federal government is the largest contributor to total health spending in the country….paid for an eroding American middle class living from paycheck to paycheck………
Continue reading How Much of Total U.S. Health Spending Is Currently Funded By The Federal Government?Mary Lou Got Some Splainin To Do
Mary Lou Retton got $2M from 2018 divorce and maybe millions more in lawsuit over her double hip replacement – yet the Olympic gymnast still raised $500k to cover medical costs after near-death battle with pneumonia………..
Continue reading Mary Lou Got Some Splainin To DoIf Your Group Health Plan Is Unaffordable………….
If I cannot afford my employer coverage, can I apply for premium subsidies through individual or family ACA plans?
Continue reading If Your Group Health Plan Is Unaffordable………….Attention TPA’s, You’re Next!
Will self-funded plans get caught up in carrier and TPA legal battles?
By Chris Deacon, J.D.
On January 12, 2024, the Department of Labor (DOL) filed a complaint against Blue Cross and Blue Shield of Minnesota (BCBSM) alleging a series of violations pertaining to the Employee Retirement Income Security Act of 1974 (ERISA).
Continue reading Attention TPA’s, You’re Next!30,000,000 Americans Rely On Federally Qualified Health Centers (FQHCs)
Over 30 million Americans rely on Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and community health clinics for healthcare, often as their only contact point.
Continue reading 30,000,000 Americans Rely On Federally Qualified Health Centers (FQHCs)Dallas Based Charitable Pharmacy Expands To San Antonio
St. Vincent de Paul (SVdP) is a Dallas-based charitable pharmacy that fills prescriptions and provides free medication for those who otherwise could not afford it. Now, the organization is expanding across Texas and providing medication to those who are homeless or in transitional housing recovering from homelessness through Haven for Hope.
Continue reading Dallas Based Charitable Pharmacy Expands To San AntonioTPA For Mysterious Austin Based Large Group Client Seeks Program Manager
Due to exciting growth, we are looking for a Program Manager to manage a new block of business with a large Client within our organization.
Continue reading TPA For Mysterious Austin Based Large Group Client Seeks Program ManagerDallas Entrepreneur Offers FREE Partial Breast Reconstruction Service
“All of them have such a powerful story,” James said of her reconstructive clients. “Some are young, others older…….Being able to do this for them and seeing them heal is so rewarding.”
Continue reading Dallas Entrepreneur Offers FREE Partial Breast Reconstruction ServiceHospital Meets With RBP Plan Sponsor
By Bill Rusteberg
A hospital reaches out to a RBP plan expressing their interest in negotiating a direct agreement. That is encouraging since many plan members view the hospital as a preferred hospital in their community.
Continue reading Hospital Meets With RBP Plan SponsorSan Patricio County Considers Terminating Insurance Consulting Agreement
San Patricio County to consider termination of Insurance Consulting Agreement during their Monday, January 29, 2024 Commissioners Court meeting.
Continue reading San Patricio County Considers Terminating Insurance Consulting AgreementEagle Pass ISD Should Feel Much Better After Reading This………
Government Pays $100,000,000 In Obamacare Commissions During Open Enrollment
CMS highlighted how four in five Healthcare.gov customers were able to find coverage for $10 or less per month for the 2024 plan year after subsidies. The agency also credited the Biden Administration for giving out nearly $100 million in Navigator awards, which lets organizations hire staff to help consumers, according to the press release.
Continue reading Government Pays $100,000,000 In Obamacare Commissions During Open EnrollmentCNN Saves Patient’s Life
Medical experts are scratching their heads over the incredible recovery of a comatose patient on life support who was not expected to survive.
Continue reading CNN Saves Patient’s LifeUninsured, Unable To Stand Upright, Patient Seeks Medical Attention at Outdoor Clinic
Nothing like a fresh air clinic with no wait times, copays, or deductibles to worry about……………
Continue reading Uninsured, Unable To Stand Upright, Patient Seeks Medical Attention at Outdoor ClinicInsurance Company Sues Minneapolis For ‘Negligence’ During George Floyd Riots
“The City’s negligence was a direct cause of the plaintiffs’ damages. The city is liable to the plaintiffs for their damages,” the lawsuit argues.
Continue reading Insurance Company Sues Minneapolis For ‘Negligence’ During George Floyd RiotsGovernment Reports 17% of In-Network Claims Denied
Illegal Aliens Sign Up For Free Obamacare in San Antonio?
Outside the NGO processing center in San Antonio Tx, Illegals that have only been in the United States for less than 48 hours were being signed up for free health insurance.
Continue reading Illegal Aliens Sign Up For Free Obamacare in San Antonio?CrowdHealth Isn’t Health Insurance… and Why That’s a Good Thing!
“Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”
Continue reading CrowdHealth Isn’t Health Insurance… and Why That’s a Good Thing!22 Men and A Cat
INCREDIBLE STORY from the history pages of Lloyds of London
By Paul Miller
A cat features in this, my favourite story from the Lloyd’s archives. I post it every now and then, for those that haven’t heard it as it’s so extraordinary.
Continue reading 22 Men and A CatAdios, Es Hora
By Bill Rusteberg
One of the hardest things a consultant can do is fire a client. Today we did just that. It wasn’t an easy decision. This is a client we’ve served for many years, earning deep friendships within the organization that will endure.
Continue reading Adios, Es HoraTeeny-Weeny PBMs Challenge The Big Boys
Startups promising lower costs and transparency challenge the largest benefit managers………….
Continue reading Teeny-Weeny PBMs Challenge The Big BoysSherlock Holms Of Insurance
By Paul Miller
Sir William Charles Crocker was a man often referred to as the “Sherlock Holmes of Insurance”.
Continue reading Sherlock Holms Of InsuranceI Just Might Be A Psychopath
By Andy Schoonover, CEO CrowdHealth
Here is a story about how I just might be a psychopath (and how I saved 88% on my medical bill in 12 minutes).
Continue reading I Just Might Be A PsychopathLloyds of London
“We now have our cars insured by Lloyd’s of London. I do not anticipate any further insurance problems” – Martin Luther King
RiskManager.us Invests In Latest Technology
RiskManagers.us official demonstrates latest cutting edge technology in front of stunned audience.
Continue reading RiskManager.us Invests In Latest TechnologyThe Best Work Comes Out of Great Relationships
By Bill Rusteberg
As a self employed insurance agent I’ve worked with hundreds of clients over the past 50 years, the result of calling on thousands more in prospecting efforts to gain more business. I’ve met all types of personalities, developing a skill few have. Understanding motivation, goals and interests is secondary to understanding moral and ethical values of those you strive to do business with.
Continue reading The Best Work Comes Out of Great RelationshipsRural-Urban Healthcare Access Gap: It’s All About The Fixed Costs
“Recognizing the key challenge of paying for the fixed costs of rural healthcare practices and facilities, government-induced and -subsidized capacity should focus on meeting what rural residents need the most, such as supporting primary care……….”
Continue reading Rural-Urban Healthcare Access Gap: It’s All About The Fixed CostsAldeen’s Sunday Morning Bathroom Read
By Doug Aldeen
In August of 2023, Advent Health fled a lawsuit alleging that MultiPlan’s business model of contracting with fellow payers and aggressively repricing out-of-network service payments is anticompetitive under Section 1 of the Sherman Act.
Continue reading Aldeen’s Sunday Morning Bathroom Read