admin – Risk Managers

The Wild And Crazy World of Insurance

Pete Tessier knows Insurance. As the host of the Insurance Podcast, he speaks to Insurance professionals about the challenges in the business. But let’s face it – no one really thinks about Insurance unless they work in it.

The Price You Must Pay To Get On A Spreadsheet

*Image created based upon real text messages between PBM and Consultant*

By Chris Deacon

At a recent event, I mentioned something in passing: “You know, the price vendors have to pay just to get on the spreadsheet.”

The Rise of A New Class of HealthCare Navigator

By Sidney Haitoff on Linkedin

As access barriers are torn down by new payment models, modern admin infrastructure, and AI, we’ll see a new class of healthcare navigator emerge. These sherpas will help curate optimal pathways, manage alerts and alarms, translate new data models, and coordinate collaboration across service sites and delivery channels, and triage issues.

Choice Benefits

Start an ICHRA and add Choice Benefits

It’s time to turbocharge your employee benefits plan and change how you shop and administer employee benefits.

You Can’t Be Bound By A Contract You’ve Never Seen

By Chris Deacon

You can’t be bound by a contract you’ve never seen. Unless, apparently, you’re a self-funded employer.

“New Frontier” In Employee Benefits For County Employees

“For county employees, navigating healthcare can often feel like another job—long waits, rushed appointments, and unclear bills. But with this new Advanced Primary Care model, employees enjoy easy, on-site access to care, at times that work with their schedules, and a location that is convenient for them. No complicated scheduling systems or insurance red tape—just care when they need it.”

Deacon Exposes Brokerage Agreement Between National Consulting Firm & Major PBM

The Streisand Effect

Brokerage Firm Earns $7 Per Script. At a statistical average of 1.2 scripts per member per month (not per employee), that can add up to a butt load of money………..

CURATIVE INSURANCE COMPANY vs ASCENSION-SETON

“For the time being, Ascension-Seton remains non-participating in our traditional network because it charges substantially higher than market rates to provide care for Curative members.” – John Bock, Vice President of Sales

ZorroRX

ZorroRX is a health benefits program designed to make healthcare more accessible and affordable for patients while reducing costs for employers. We partner with hospital pharmacies to offer $0 copays on medications, free telehealth visits with specialized pharmacists, and dedicated concierge support.

Amazing Technology

You just got a balance bill from a hospital. “You owe us $30,000 because your insurance company underpaid us!” was the note on the bill. “Pay up or we’ll send you to collections and you will forever be labeled as a DEADBEAT!”

Eliminating Group Health Plans Could Benefit Workers

Study indicates that replacing group health plans with individual plans will benefit workers…………

CVS Caremark Drops Coverage of Popular Weight Loss Drug

SOURCE: Fox Business (READ THE LAST TWO PARAGRAPHS)

CVS Caremark, one of the three major pharmacy benefit managers (PBM) in the U.S., stopped coverage for Eli Lilly’s popular weight-loss drug Zepbound, blaming drugs like it for driving up overall plan costs.

Texas News Anchorette Goes Viral

KSAT anchor goes viral for ‘speaking the truth’ about Texas leaders

KSAT12 anchor Stephania Jimenez has gone viral after “speaking the truth” about Texas leaders and their response to the deadly flooding that has killed over 80 people in the state over the Fourth of July weekend.

More Reasons Why Employers Are Getting Out of The Health Insurance Business

“The Big Beautiful Bill, signed into law by President Trump on July 4, 2025, spans nearly 900 pages and touches numerous aspects of federal policy. Nestled within this lengthy legislation are employee benefits provisions that will require employers to navigate new rules, opportunities, and compliance requirements.” – Amundsen Davis

The TPA Network Agreement – The Wooley Mammoth in the Room

By Bill Hennessee

Question: What prevents all of the best healthcare savings solutions to be implemented in large self-insured companies?! Answer: The TPA network agreement.

Me Too Brokers

By Bill Rusteberg

It’s easy to spot a Me-Too Broker. You know the type. The kind that goes along to get along. Remember Little Johnny in second grade? He was the teacher’s favorite. Remember that? Well………..Little Johnny changed his name to John and he’s now a group health insurance broker posing as a consultant.

Billy Explains Medicaid In 4 Minutes

Bill sets the record straight on the Big Beautiful Bill.

McAllen ISD Faces $4.8M Health Insurance Shortfall

“Health insurance woes took center stage at the McAllen ISD Board Workshop on May 28, 2025, as officials revealed a projected shortfall of $4.8 million for the district’s health insurance plan.”

Say Goodbye to Scheduled Meetings: The Benefits of Impromptu Collaboration

“One of the main advantages of impromptu collaboration is its ability to foster quick thinking and adaptability. “ – Josua Evans

Centene Corporation – The Biggest Health Insurance Carrier You Never Heard Of

By Patrick Moore

5 years ago when I was building a slide deck about the biggest health insurance companies in the 🇺🇸 the named popped up. I spent my career on the group side so it was never really a company i paid attention to. They focus alot on the medicaid and the individual market under a brand called Ambetter Health.

Will Employers Replace Defined Benefit Plans with Defined Contribution Plans?

“Employers should assess employee preferences for group plans versus CHOICE arrangements, documenting decisions to demonstrate fiduciary prudence…...Employers must ensure group coverage remains comprehensive and cost-effective compared to CHOICE arrangements…… Fiduciaries may need to evaluate whether continuing group plans……….”

Frontier Direct Care

The suspect on the left is Joe Wilson. Don’t let him in the door he might sell you something. He’s that good.

Employer Built Stop Loss

SOURCE: Aegis Risk

Stop loss insurance is getting more expensive. Average rate increases for 2026 are expected to be in excess of +20%. Higher prescription drugs costs is one of the main cost drivers. However, there are alternatives for plan sponsors to consider.

Ruben Edelstein

By Bill Rusteberg

Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.

MedSave’s Simple Plan

Structuring a self-funded health plan requires positioning of more moving parts than a Swiss watch. All must sync in perfect harmony but often don’t. And the costs can mount up fast, often costing more than $100 per employee per month in administration fixed costs alone.

Commissioner’s Bulletin # B-0005-25

June 5, 2025

To: Insurance companies writing personal automobile and residential property policies in Texas

Re: 2025 HelpInsure.com price comparisons data call

The Texas Department of Insurance (TDI) issues this data call to gather information for the HelpInsure.com website. HelpInsure is a resource for Texas consumers who are shopping for personal automobile or residential property insurance. Insurance Code Section 32.102 requires that TDI provide this information. Responses for this data call are due by July 11, 2025.

There’s No Such Thing As A Million Dollar Claim

By Bill Rusteberg

A few years ago we were having a few late afternoon beers, as was customary on most business days, at the CEO’s private office in West Texas. Although I was not a “regular” since I lived many miles away, when I had occasion to visit I always looked forward with keen anticipation to the late afternoon “business meeting” that would invariably take place. It was always an enjoyable time, with much banter back and forth, with an occasional visitor or two dropping by to add to the atmosphere.

Meet George, Your New Health Insurance Broker

George is an incredibly talented health insurance broker. He writes and services more business than all the largest brokerage houses combined in days gone by.

Allstate Benefits Group Health joins Nationwide®

Peyton Manning is super excited about the news!

TRS ActiveCare 2025-2026 Benefits & Rates

Texas government health plan for pubic school employees has published 2025-2026 benefits and rates. Go here, pages 24-37 for details.

South Texas Politics – A True Story

“You are short sighted. When the new board gets in you will regret this.” – TPA

The year was 2004. The TPA was Houston based. The group was a South Texas school district located in the Lower Rio Grande Valley.

The Jacked Up World of Cost Containment

Victor Lustig

The American health care delivery system is about as jacked up as jacked up can get. Employers scramble to mitigate rising health care costs by hiring outside cost containment firms employing any number of strategies. This additional plan expense can effectively double or triple fixed costs leaving fewer budgeable dollars to pay claims.

Telemarketing Script Kills It

Attention Insurance Salesmen! Try this script and increase your sales overnight!

How Is This Legal?

How is this legal?

How Much Does An ER Visit Cost?

By Josh Nakka

Most people guess a couple thousand dollars, but the reality can be far more shocking. An ER bill can sometimes top $20,000.

Script Sourcing Third Party Vendors Save Plan Sponsors Millions In Prescription Drug Spend

PBM Sales Rep. Reacts To The News……………….

Plan sponsors seeking solutions to high cost prescription drugs must understand a single source solution is not their best bet. Lowering Rx costs is all about sourcing the right drug at the right price. It’s that simple.

How To Convert A Fake Billed Charge To A Real Price In Seconds

“Everyone knows a billed charge is bull shit. It’s like a sticker price on a new car. No one ever pays full billed charges unless they are brain dead. Leon has developed an AI tool that cuts through the bull shit” – Bill Rusteberg

Normandy Seeking P&C Agents

You read that right. Three simple steps, no premium commitment, and you’re getting appointed today.

Missing Toothbrush Found After 52 Years

Chinese man, 64, finds toothbrush he swallowed at age 12 stuck in intestine, needs surgery

The Cash Pay Revolution Continues

“Cash has more power and influence than a health insurance card with a logo” Molly Mulebriar

The Curative Zero Card has a new name: the Curative Cash Card. Why? Because it now covers even more services, and makes it even easier for members to use their $0 benefits.

Rx Flyer Found In Lonely Rural Mailbox

In a remote part of a South Central Texas county there stands a lonely mailbox, the last one on a rural route 12 miles from a city no one has ever heard of. It’s a window to a wider world of strange and amazing things……………

Carrier Ditches Traditional Group Insurance Plans To Promote ICHRA

Insurance company announces it will exit the fully-insured, self-funded and level funded market to concentrate on individual policies through Individual Coverage Health Reimbursement Arrangements (ICHRA).

“We are committed to helping employers find affordable health insurance options for their employees. We believe that one answer can be found in our individual plans and are excited to provide a solution for employers in CT through an Individual Coverage Health Reimbursement Arrangement (ICHRA).”

Mark Cuban Floats Bold Healthcare Plan: ‘Zero Premiums To Insurance Companies’ With A Cash-Pay Revolution

“This is not a new idea but a good old idea. Cuban proposes the government provide the equivalent of a $50,000 stop loss policy for all Americans – an ACA Re upgrade. Let’s do it!” – Molly Mulebriar

Federal Judge Rules Providers Can Sue To Enforce Unpaid IDR Awards

“Get your check book ready………………” – Don Pedro

Eliott Listman – Allia Group – Litigation CEO

A federal court in Connecticut ruled that providers can sue to enforce unpaid IDR awards under the No Surprises Act, rejecting insurer arguments that there’s no private right of action.

Even The Clouds Know

Picture stolen from Josua R …….

Do we still need traditional PBMs?

“It’s evidently possible to run an effective discount network without the associated bloat and misaligned incentives of a traditional PBM…..”

Bird Dogging Jilted Lovers

ICHRA administrators don’t need brokers but they pretend they do. They often play both sides, direct sales and broker introduced door opener sales.

Nobody Hates Insurers Like Doctors

By Craig Gottwals

“While hospitals and insurers are milking employers for two to six times Medicare every chance they get, doctors get the stuffing kicked from them in the insured market. “

Medicare and Social Security Go-Broke Dates Pushed Up Due To Rising Health Care Costs

Medicare is on track to be broke in eight years. If Medicare For All is implemented then it stands to reason the Medicare risk pool will benefit by the addition of younger and healthier people. Odds makers expect that to happen because it will. Medicare won’t be a risk pool of oldies anymore.

Nothing Is Forever

Government “enhanced” premium assistance for ACA plans is set to expire at the end of this year.

The ER Is Bursting at the Seams — Employers Hold the Key to Change

Employees visit ER “as a quick fix for their healthcare needs, particularly for mental health conditions.”

Curative Insurance Company Lands Large Florida School District

“With employees facing a 20% health-insurance increase, the Volusia County School Board has pivoted away from its longstanding carrier and awarded a $153 million contract to Curative, a startup that’s been in the business for less than three years.”

Houston’s ODPC Beats A Poke In The Eye

Houston Residents Rejoice At The News – 24/7 On Demand Health Care

Need to see a doctor but don’t want to wait days and weeks to see one? Tired of waiting in a crowded, germ filled waiting room filled to capacity with coughing and sneezing sick people whose appointment was booked for the same time as yours, all waiting to see the same doctor while snot nosed kids run around the waiting room playing grab ass?

The Most Outrageous Insurance Salesman That Ever Lived Explains How He Does It…

King Murray – The Most Outrageous Insurance Salesman That Ever Lived! is an interesting character. This video is time stamped where in two minutes he explains his secret for success…………

Build-Your-Own Health Plan

DIY and Stop Feeding the Beast

“If you’ve got access to a savvy self-funded plan backed by direct contracts or Reference-Based Pricing? Take it. That’s the best option in the country right now.”

Pass-The-Hat Risk Management

Hospital Cover Charges & Whorehouse Financing – A true story based on fabricated facts…………

A self-funded health plan that moved away from managed care networks two decades ago knows the secrets of health care finance in this country.

The PBM Survival Kit You Didn’t Know You Needed… But Absolutely Do

By Josua R

Tired of claw backs, DIR fees, and being gaslit by pharmacy benefit managers? Here’s your starter pack for surviving the daily abuse:

Insurance Tomb Stoning

Tomb Stoning is where unscrupulous insurance agents use the names of dead people and create insurance policies for them. Agents often work on large up front commissions so get money almost immediately a new policy is signed.

Does Texas HB 2015 Apply To ICHRA Plans?

And Your Answer Is…………..□ YES □ NO

ICHRA 2026

SOURCE: Venteur

One of the most notable trends in the 2026 filings is the rise of ICHRA-specific plans, which are filed off-exchange only and are priced up to 20 percent lower than their on-exchange counterparts.

$10 Admin + Cost of Risk = Current Cost/4

By Monte Jennings, President Sentia Health

Sentia has automated the entire health insurance process. We provide the EMR to practices, price the procedures 50% ABOVE Medicare, and pay for work performed in real time.

Most Americans Back Trump’s ‘Radical’ Actions To Reform Health Care Industry

The vast majority of Americans support President Donald Trump’s actions to make medical prices more transparent, according to an exclusive poll shared with The Daily Wire.

What’s This Going To Cost Me? Sorry, I Can’t Tell You!

SOURCE : Patient Rights Advocate

New national poll confirms what we’ve known all along: Americans want real prices in healthcare—and they want them before they get the bill.

Prison Inmate Health Insurance

Catastrophic Inmate Medical Insurance

Catastrophic Inmate Health Coverage

SOURCE: ACCG

Catastrophic Inmate Medical Insurance is an insurance policy with a structured reimbursement model for which eligible medical expenses incurred outside the walls of the jail can be reimbursed.

Inmate Medical Insurance

SOURCE: IAT

IAT has specialized in stop-loss insurance solutions for the adult correctional market since 1984. Our Inmate Medical program provides prisons and jails valuable protection against unknown, potentially catastrophic medical claims.

Dental Insurance For Texas Retired Teachers

Texas Retired Teachers Association (TRTA) knows Retired School Employees like you. AMBA knows insurance. Together we can provide you with the dental and vision plans you need to keep your teeth and eyes healthy now and for years to come.

Johnny’s Doctor Is a Little Strange |

Another Rojas Truth Bomb

By Dutch Rojas

Health Insurance Premiums are not high because care is expensive.

Student Accident From Chubb

SOURCE: Chubb

Many schools seek to comply with state educational code requirements and limit their general liability exposure by providing student accident insurance to students in kindergarten through 12th grade.

Capital Rx Introduces Judi

Capital Rx Expands Into Care Navigation with Acquisition of Amino Health

Through a new acquisition, Amino Health will become Capital Rx’s patient-facing care navigation solution called Judi Care.

The Employer’s Dilemma: When the Fully Insured Plan No Longer Works, What’s Next for Employers?

SOURCE: Medcity News
By Ben Light on June 12, 2025

“The results are clear, too. Recent data from Oscar Health(Opens in a new window) shows that the individual market’s vast risk pool — stabilized across over 24 million lives — has not only maintained the cost of health insurance. It’s actually forcing it down, with 2024 costs trending about 4% lower than employer costs.

The Truth About Group Health Insurance

Status Quo Health Insurance Broker Leading His Clients

By Bill Rusteberg

The Land of Lemming is better than the Land of ICHRA” is a common belief. But is it?

BCBS Michigan Sued Over Alleged Scheme to Extract Excessive Fees from Self-Insured Health Plans

Employer Sues BCBS Michigan Alleging Hidden Fees

By Mark Flores – Executive Vice President and Co-Founder at AVYM Corporation

Blue Cross Blue Shield of Michigan is under fire again—this time accused of siphoning off millions in excessive fees from self-funded employer health plans.

Doctor Explains Benefits of Fasting

TESTAMONIALS:

“When i was in college i fasted a lot, the biggest benefit i noticed was a 22% increase in ability to pay tuition”