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.

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“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.”

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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.

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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

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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.

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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.

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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……….”

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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.

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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.

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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.

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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.

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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).”

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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

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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.

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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.

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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?

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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.

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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.

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