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Veterans Day 2024
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
I knew little of my father’s participation in WW2 until after he died. Unlike veterans of today his generation didn’t talk much about it. Their quiet pride was enough, understood by all. The following recounts the Battle of Hatten in which my father was a participant. – Bill Rusteberg
Continue reading Veterans Day 2024Protection Money Is A Form Of Insurance
You Better Pay Up If You Want To Stay Healthy!
“Protection money, also known as “Pizzo” in Italian, was initially presented as a form of insurance.”
Continue reading Protection Money Is A Form Of InsuranceWhy Dental Insurance Is A Terrible Investment
Dental insurance is proof insurance does not always make sense……………
Continue reading Why Dental Insurance Is A Terrible InvestmentOld Fashion Non-ACA Insurance Products To The Rescue
Attention Health Insurance Agents
Tired of selling health insurance? Yes, I know, it’s a really dumb question but humor me and read on.
Continue reading Old Fashion Non-ACA Insurance Products To The RescuePasture, Rangeland, & Forage Insurance
DEADLINE TO APPLY FOR COVERAGE IS DECEMBER 1
Pasture, Rangeland and Forage (PRF) Insurance protects hay and livestock producers against loss of forage due to lack of rainfall on acres used for grazing or hay. The plan pays indemnities based on historical rainfall levels determined by a rainfall index.
Continue reading Pasture, Rangeland, & Forage InsurancePotential Employee Benefits Changes in Second Trump Term
“The new administration may still seek to make significant changes such as eliminating the ACA employer mandate penalties, streamlining ACA reporting, expanding HSAs, and codifying the ICHRA rules into statute.”
Continue reading Potential Employee Benefits Changes in Second Trump TermHealthcare Insurers Take Note: New Federal Whistleblower Program is Coming for You
November 6, 2024 David E. Leach Caroline J. Berdzik Scott R. Green
Key Takeaways:
- New Corporate Whistleblower Awards Pilot Program incentivizes the reporting of corporate misconduct with the whistleblower possibly receiving upwards of $30 million
- Healthcare insurance fraud schemes are one of the focuses of the program
- The program ensures whistleblower confidentiality
Walgreens Agrees To $100,000,000.00 Settlement
Walgreens agrees to pay $100 mln to resolve lawsuit over generic drug pricing
Nov 4 (Reuters) – Walgreens (WBA.O), opens new tab has agreed to pay $100 million to settle a proposed class action lawsuit accusing it of fraudulently overcharging customers for a decade when they bought generic drugs through private insurance, Medicare or Medicaid.
Continue reading Walgreens Agrees To $100,000,000.00 SettlementDJT To Shake Up Health Care?
Donald Trump returns to the presidency with big ambitions to shake up health care
Republican Donald Trump has won the presidency, marking a new era for federal health agencies and the industries they oversee. The president-elect campaigned on promises to shake up public health institutions, reshape federal health programs, and slash high costs across the system.
Continue reading DJT To Shake Up Health Care?You Can’t Fight Against The Future
“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg
Continue reading You Can’t Fight Against The FutureEmployers Look to Cut Healthcare Program Costs and Boost Affordability
Employers Look to Cut Healthcare Program Costs and Boost Affordability
“Employers are adopting various strategies to ensure the affordability of their healthcare programs for both their companies and employees.
Continue reading Employers Look to Cut Healthcare Program Costs and Boost AffordabilityNo Surprises Act Independent Dispute Resolution Outcomes for Emergency Services
No Surprises Act Independent Dispute Resolution Outcomes for Emergency Services
“We analyzed public IDR data from 2023 for the most common disputed professional service: evaluation and management of a moderate to severe emergency medicine visit.
Continue reading No Surprises Act Independent Dispute Resolution Outcomes for Emergency ServicesTerm Life Like With – No A.R.T.
Currently, most all Term Products are designed to turn into Annual Renewable Term at the end of the guaranteed period.
Continue reading Term Life Like With – No A.R.T.This Makes No Sense
“Most political subdivisions have never bid out the dominant risk factor of their health plan that accounts for 90% of plan spend. Instead they have historically “gifted” public funds through intermediaries who have negotiated secretive contracts with health care providers they can’t see nor audit.” – Bill Rusteberg
Continue reading This Makes No SenseNovember 6, 2024
Micky is feeling spunky today………..
Continue reading November 6, 2024Internal Emails Reveal Carrier’s Pricing Strategy
“UnitedHealth had already reduced payments from 450% of what Medicare pays — the benchmark that many insurers use as a starting point for their own figures — to 250%, and the company planned to drop it further to 150%, according to the email……..Such a cut would have put UnitedHealth below national averages: Employers and private insurers paid on average about 250% of Medicare’s reimbursement in 2022…..”
Continue reading Internal Emails Reveal Carrier’s Pricing StrategyDefined Contribution Plans Are Becoming Popular Out Of Necessity
Boon-Chapman Announces Appointment of Kari L. Niblack, Esq., as President
Austin, TX, November 5, 2024 — Boon-Chapman, a leading claims administration, cost containment and care navigation company, announces the appointment of Kari L. Niblack, Esq., as President. Niblack brings twenty-five years of expertise in leading and transforming multiple corporations in the self-insurance ecosystem and has a proven track record of driving hyper-growth and innovation.
Continue reading Boon-Chapman Announces Appointment of Kari L. Niblack, Esq., as President‘Cash-For-Coverage’ Health Plans Could Win The Elections, Exec Says
Hallelujah! A Bi-Partisan Health Plan Emerges From The Chaos Of A Broken System
The head of an ICHRA administrator explains why the plans may emerge with bipartisan support.
Continue reading ‘Cash-For-Coverage’ Health Plans Could Win The Elections, Exec SaysIndependent Pharmacies Sue GoodRx Over Price-Checking Strategy
“The usual PBM strategy cuts an independent pharmacy’s share of the prescription revenue to just 3 cents per pill dispensed, and the GoodRx relationships with the PBMs cut the independent pharmacies’ share of the revenue even more,”
Continue reading Independent Pharmacies Sue GoodRx Over Price-Checking StrategyHealthCare.gov Open Enrollment Starts Amid Rising Interest in ICHRAs
Interest in ICHRAs has surged, with a 100% increase in search activity compared to last year.
Continue reading HealthCare.gov Open Enrollment Starts Amid Rising Interest in ICHRAsProviders’ Winning Streak In No Surprises Act QPA Litigation Ends As Appeals Court Overturns A Prior Ruling
Plan Sponsor Reacts
The TMA is 4-0 in contesting aspects of the No Surprises Act. At the appellate level, the TMA is 1-1
“The decision means insurers can calculate qualifying payment amounts using factors that provider advocates say should not enter into the equation.”
Continue reading Providers’ Winning Streak In No Surprises Act QPA Litigation Ends As Appeals Court Overturns A Prior RulingIs Snejina Zacharia The Biggest Auto Insurance Broker On The Planet?
SOURCE: MIT Graduate Saw An Opportunity & Seized It.
When a minor accident sent Snejina Zacharia’s car insurance premium skyrocketing, she went in search of a better, cheaper policy. She discovered insurance shopping is too often exasperating, and inefficient, filled with hours of phone calls, and an inbox overflowing with spam.
Continue reading Is Snejina Zacharia The Biggest Auto Insurance Broker On The Planet?Mary Talley Bowden MD
At BreatheMD, we prioritize our patients over politics.
Continue reading Mary Talley Bowden MD40 Years Of Managed Care – So Much For Your Promises!
So much for your promises. You’ve given me nothing but shattered dreams……………….
Continue reading 40 Years Of Managed Care – So Much For Your Promises!A New Type of Health Plan You Never Heard Of
MEDSAVE MANAGEMENT LLC is pleased to announce a new health plan option members may choose when seeking medical care. This program is designed for self-funded health plans interested in achieving additional plan savings while improving benefits at the same time without disrupting existing relationships.
Continue reading A New Type of Health Plan You Never Heard OfWelcome to Plan Stewards
Empowering Health Plans and Their Members
At Plan Stewards, we’re more than just a Third-Party Administrator. We’re your trusted partner in navigating the complex world of healthcare benefits. With over 150 years of collective experience, our team is dedicated to providing cutting-edge cost containment solutions, groundbreaking direct contracts, and adaptable plan designs.
Continue reading Welcome to Plan StewardsMiracle OTC Drug Hits The Market
Half of America To Benefit.
Big Pharma reports “Initial sales will be limited to Blue States. Red States are immune.“
California, New York, Oregon, Washington, and Illinois state officials have promised to stop Trumpenol from hitting retail shelves citing “adverse side effects.”
Continue reading Miracle OTC Drug Hits The MarketAttention Brokers: One Stop Carrier Appointment Is Here
ATTENTION BROKERS: Core Benefits Group will assist you in getting contracted with any carrier active in your area. Go here Health Contract Request.
Continue reading Attention Brokers: One Stop Carrier Appointment Is HereWeight-Loss Drugs Didn’t Curb Health Costs Within Two Years
Drugs like Wegovy may trim your waistline but not medical costs, according to an analysis of U.S. health insurance claims shared with Reuters.
Continue reading Weight-Loss Drugs Didn’t Curb Health Costs Within Two YearsSmithRx is Transforming Pharmacy Benefits
Our mission at SmithRx is to secure the lowest cost prescription drugs, upholding transparency and integrity while prioritizing the best interests of both employers and patients.
Continue reading SmithRx is Transforming Pharmacy BenefitsThe American Health Care Crisis – Is It Time For Civil Disobedience?
By Bill Rusteberg
The American health care delivery system has reached a boiling point. The average working American can no longer afford health insurance and those who can often find they can’t afford to use it.
Continue reading The American Health Care Crisis – Is It Time For Civil Disobedience?PART TWO: More Reasons Employers Want Out Of The Health Insurance Business
Part Two of a continuing series pointing out reasons why employers want out of the health insurance business. Part One and Part Two bring the total number of reasons employers want out to 14 and counting…………….
Continue reading PART TWO: More Reasons Employers Want Out Of The Health Insurance BusinessFirst Primary Care DPC Is Hiring Full-Time Physicians
Ready to quit the billing game and fall in love with practicing medicine again? Join the First Primary Care team of medical professionals, from MDs and DOs to MAs and FNPs, that change the way doctors and patients experience healthcare. – Geetinder Goyal, MD – CEO, First Primary Care
Continue reading First Primary Care DPC Is Hiring Full-Time PhysiciansSeven More Reasons Why Employers Want Out Of the Health Insurance Business
With the passage of the Affordable Care Act (ACA) effectively turning private health insurance plans into a de facto government utility managed by bureaucrats in far away places, plan sponsors have become increasingly subjected to freedom robbing government mandates and punishing sanctions.
Continue reading Seven More Reasons Why Employers Want Out Of the Health Insurance BusinessInsurance Rebates In Off-The-Books Account Raises Eyebrows
“Third-party vendor quietly held insurance rebates that accrued to $8 million in an off-the-books account…..”
Continue reading Insurance Rebates In Off-The-Books Account Raises Eyebrows
If you have questions about attending contact Jamaal Lewis at jalewis@alm.com. If you have questions about sponsoring please contact Craig Williams at crwilliams@alm.com.
America’s Leading Writer of Innovative Insurance Programs
McGowan Program Administrators (MPA) is America’s leading writer of innovative insurance programs. MPA is a Managing General Underwriter and Program Manager. MPA designs, administers and markets highly-specialized programs of insurance. These programs are available exclusively through MPA. They are offered on “A” Rated, Admitted Paper and are available in all 50 states.
Continue reading America’s Leading Writer of Innovative Insurance ProgramsGeorgia Earns Millions Off ACA Website
The state is already making hundreds of millions of dollars from enrollment fees on the site in partnership with brokers.
Continue reading Georgia Earns Millions Off ACA WebsiteStay Tuned… FTC Seeks to Breathe Life Back Into Non-Compete Ban
Sean R. Gallagher, Jason T. Weber and Ross T. Weimer
October 25, 2024
This past week, the FTC appealed a Texas federal court’s August ruling that blocked nationwide enforcement of the non-compete ban. The non-compete ban will remain blocked during the pendency of the appeal process. However, the outcome of the appeal will determine: (1) whether the non-compete ban remains blocked; and (2) the future scope of the FTC’s regulatory authority. There are three court challenges to the non-compete ban. The status of those challenges (including appeals) is detailed below:
Continue reading Stay Tuned… FTC Seeks to Breathe Life Back Into Non-Compete BanCutting Waste In Government Controlled Healthcare
SOURCE: Efficiency Commission Would ‘Unburden’ Us from a Federal Healthcare Nightmare
“The American healthcare system is increasingly falling behind as critical funds are funneled into bureaucratic red tape rather than innovation. Administrative costs have exploded, diverting resources that could otherwise fuel groundbreaking medical advancements. Instead of prioritizing cutting-edge research and life-saving treatments, far too much healthcare spending is consumed by paperwork, compliance protocols, and outdated systems. This misallocation of funds stifles research, patient care, and global competitiveness.”
Continue reading Cutting Waste In Government Controlled HealthcareWorksite Marketing – This Is What Sells
“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
Voluntary employee benefits is a huge and lucrative market for insurance agents. There are tons of competition in that space. To be successful you must be different and better.
Continue reading Worksite Marketing – This Is What SellsBaskin-Robbins Disproves HR Myth But The Salesman Is Dungeoned
A Fairy Tale By Molly Mulebriar
Once Upon A Time a health insurance agent presented an ICHRA proposal to the wicked witch of HR, a bald headed spinster known as Ms. No Never…………..
Continue reading Baskin-Robbins Disproves HR Myth But The Salesman Is DungeonedHere’s The Company Who Decides Whether To Pay For Health Care for 100,000,000 Humans
Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.
Continue reading Here’s The Company Who Decides Whether To Pay For Health Care for 100,000,000 HumansAre TML, TAC, and TRSAC Health Plans Obsolete?
Have the Texas Municipal League (TML), Texas Association of Counties (TAC) and the TRS ActiveCare (TRSAC) health plans become obsolete in today’s market?
Continue reading Are TML, TAC, and TRSAC Health Plans Obsolete?Government Run Health Care Doesn’t Pay Squat
Melody Learns The Truth After Getting What She Wished For
Ana Delian, an intensive care nurse, earns $18 a month . “They pay you little and you work loads.”
Continue reading Government Run Health Care Doesn’t Pay SquatSugar
Aldeen’s Sunday Morning Bathroom Read
Send Lawyers, Guns and Money Part III
The American Medical Association recently oined the fray and sued Multiplan earlier this week in federal district court in Chicago. At issue is MultiPlan’s business model. Instead of determining their own out-of-network rates, insurers can outsource that function to MultiPlan, which promises to save them money on those claims. In many cases, MultiPlan uses an algorithm-based tool to recommend a payment level — and receives a portion of the difference between the recommendation and the original out-of-network bill, giving the company a financial incentive to recommend lower rates. The majority of U.S. insurers, including the 15 largest in the country, use MultiPlan to determine out-of-network payments.
Continue reading Aldeen’s Sunday Morning Bathroom ReadHospitals Hit The Motherload With NSA IDR
Independent Dispute Resolution (IDR) Decisions Appear to Greatly Increase Claim Costs for Self-funded Health Plans and Other Payors
Continue reading Hospitals Hit The Motherload With NSA IDRBCBS To Remove Houston’s MD Anderson From Medicare, Medicaid Networks
Blue Cross and Blue Shield of Texas to remove Houston’s MD Anderson Cancer Center from Medicare, Medicaid networks
HOUSTON – Blue Cross and Blue Shield of Texas announced it has made the decision to remove MD Anderson Cancer Center in Houston from its Medicare Advantage PPO, Blue Cross Medicare Advantage HMO, and Medicaid networks effective Nov. 1, 2024.
Continue reading BCBS To Remove Houston’s MD Anderson From Medicare, Medicaid NetworksFrontier Acquistion of Asserta Health Valued At $10,000,000
September 25, 2024
Bell Nunnally Represents Primary Care Network Frontier Direct Care in $10M Acquisition of Health Plan Provider Asserta Health
SOURCE: Bell Nunnally & Martin LLP
Bell Nunnally, led by Partner Ray A. Balestri and Senior Associate Joshua T. Smith, represented Harlingen, Texas-based primary care provider network Frontier Network, Inc. (d/b/a Frontier Direct Care) in its acquisition of Salt Lake City, Utah-based Asserta Health Inc. Asserta offers employers access to a cash-driven health plan, enabling self-insured and level funded employers to deliver health care benefits to their plan members. The deal, executed through stock-for-stock exchange, had an estimated value of $10 million.
Continue reading Frontier Acquistion of Asserta Health Valued At $10,000,000Seattle Hotel Owners Must Provide Employees With Families $20,232 Per Year In Health Care Benefit Access
2025 Seattle Hotel Employees Ordinance Expenditure Rates
SOURCE: 2025 Seattle Hotel Employees Ordinance Expenditure Rates
The Seattle Office of Labor Standards (“OLS”) announced the adjusted rates for 2025 health care expenditures required by the Improving Access to Medical Care Hotel Employees Ordinance, Seattle Municipal Code (SMC) 14.28.
Continue reading Seattle Hotel Owners Must Provide Employees With Families $20,232 Per Year In Health Care Benefit AccessA Common Sense Alternative To TRS ActiveCare For Region One School Districts?
Most Texas school districts are unaware of a new health plan option that’s quickly fulfilling market demand across the country. “Why haven’t we heard about this? is a common question we get from district officials. “What is it and how does it work?” they ask. Dr. Eric Bricker explains it best in this short informative video.
Continue reading A Common Sense Alternative To TRS ActiveCare For Region One School Districts?Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans
NEW YORK–(BUSINESS WIRE)–Oscar Health, Inc. (“Oscar”) (NYSE: OSCR), a leading healthcare technology company, today announced it will bring the Oscar experience to more individuals, families, and businesses through the ACA marketplace in 2025. Oscar is introducing affordable health insurance products that empower people to pursue a healthy life on their terms with:
- Services built around personal health needs and preferences.
- Established networks providing multiple paths to high-value clinical care.
- Technology solutions to help members manage their health and make informed choices.
How Much Are You Paying For Your Pooling Point?
Most fully-insured group health plans have a claim pooling point which acts as a stop loss insurance policy against high unexpected individual claims. The scheme is intended to mitigate rate increases by transferring specific risks.
Continue reading How Much Are You Paying For Your Pooling Point?Hospital Prices Have Increased 220% Since 2000
Hospital price increases since 2000 outpaced inflation by more than double, Baker Institute report says
SOURCE: Rice University
Hospital service prices surged more than 220% between 2000 and 2022, according to a report from Rice University’s Baker Institute for Public Policy.
Continue reading Hospital Prices Have Increased 220% Since 2000PPO Discounts
What Do Car Dealerships & PPO Networks Have In Common?
Would you pay $25 pepm to access a PPO network to get a 50% discount off a 600-1000% markup?
Continue reading PPO DiscountsTRS ActiveCare Financial Update Assumes 9% Increase In 2025
TRS ActiveCare trustees were given updated financials at their September 2024 quarterly board meeting with financial projections through 2027.
Continue reading TRS ActiveCare Financial Update Assumes 9% Increase In 2025Is Dexcon Covered Under The ACA Preventive Care Mandate?
“This Notice expands the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) under section 223(c)(2)(C) of the Internal Revenue Code (Code) without a deductible, or with a deductible below the applicable minimum deductible for the HDHP….”
Continue reading Is Dexcon Covered Under The ACA Preventive Care Mandate?Anatomy of Public Entity Insurance Corruption
“The only way that we would be able to get into any school district was to be able to directly have a relationship with the decisionmakers — the school board, the trustees. We wouldn’t waste time on people where we couldn’t make money. We would contribute to the opponent of those (board members) who did not vote for us.” – Criminal Turned FBI Informant
Continue reading Anatomy of Public Entity Insurance CorruptionUninsurable? Nope, No Such Thing
There is no such thing as an uninsurable.
Continue reading Uninsurable? Nope, No Such ThingThe State of US Healthcare
By Dutch Rojas
30% of physicians will retire in the next ten years.
Continue reading The State of US Healthcare45,000 Agents & 4,800 Agencies Can’t Be Wrong
The Largest ACA Quoting & Enrollment Platform On The Planet
How would you like to have 45,000 agents working for you while you’re at home sipping coffee in your pajamas? Two young techy types have done just that! That’s “Working Smart.”
Continue reading 45,000 Agents & 4,800 Agencies Can’t Be WrongCuring Cancer (Affordability)
Another powerful 27 minute video featuring Ron Piana. You don’t want to miss this one! He explains a method that effectively causes “very rapid cell death” that those within “The Fortress of Dogma” refuse to acknowledge.
Continue reading Curing Cancer (Affordability)Fruit Loops
Ex-FDA food expert reveals why Kellogg’s Froot Loops is worst cereal in US- amid calls for cancer chemical ban…………
Continue reading Fruit LoopsWhat’s Good For The Goose Is Good For The Gander
Should fee-based insurance consultants be paid the same as commission – insurance agents and brokers for producing the similar results?
Continue reading What’s Good For The Goose Is Good For The Gander“Nobody Spends Somebody Else’s Money As Wisely As He Spends His Own”
The MotivHealth story began almost 20 years ago when two friends were having a conversation about the rising cost of health insurance premiums. The conversation went something like this:
Continue reading “Nobody Spends Somebody Else’s Money As Wisely As He Spends His Own”Rejoice! Government Promulgates Tax Free Condom Ruling
Hello Down There….Trouble Breathing?
Two unelected government bureaucrats, Elizabeth Choi and Amy S. Wei of the Office of Associate Chief Counsel, have issued their ruling that provides a safe harbor for condoms.
Continue reading Rejoice! Government Promulgates Tax Free Condom Ruling$2.2 Billion Settlement Causes Zantac Heartburn
ZANTAC is a medication used to decrease stomach acid production. It was commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. It can be given by mouth, injection into a muscle, or injection into a vein.
Continue reading $2.2 Billion Settlement Causes Zantac HeartburnICHRA vs Group Plans
If we haven’t convinced you yet, let’s do a little side-by-side comparison of group plans and ICHRAs
Continue reading ICHRA vs Group PlansVenteur
Advertisement in Las Vegas airport
Continue reading Venteur