There’s good news for proponents barking “We need Medicare for all!”. It’s here.
Continue reading Medicare For All Is Here!Author: admin
U.S. Senate Bill Sounds Good But How Effective Will It Be?
There’s been a lot of hype over this bill. But is all the enthusiasm warranted?
U.S, Senate Bill To the Public Health Service Act to provide for expanded hospital and insurer price transparency will probably pass but will it have it’s entended effect? We think its not so likely as evidencd by past history in which most hospitals simply choose to ignore the law and pay the fines.
Continue reading U.S. Senate Bill Sounds Good But How Effective Will It Be?Aldeen’s Sunday Morning Bathroom Read (“If you RBP, you gotta check the FAP” Part I of II Edition)
This is one of Aldeen’s best Sunday Morning Bathroom Reads. We suggest it should be extended as a Monday through Saturday Bathroom Read for his irregular readers.
Continue reading Aldeen’s Sunday Morning Bathroom Read (“If you RBP, you gotta check the FAP” Part I of II Edition)Managed Care Network Quiz
Healthcare Class 101 is now in session. Read each question carefully and answer to the best of your ability. There are no trick or multiple choice questions. You have three minutes to complete the test.
Continue reading Managed Care Network QuizAmerican Health Insurance Will Bankrupt You
Most Americans have health insurance through their employer. But according to this article 45% of employees have medical debt and its impacted their ability to put food on the table……….
Continue reading American Health Insurance Will Bankrupt YouWhat Do You Call The Guy Who Graduated At The Bottom Of His Class In Medical School?
“Somewhere in the world there is the world’s worst doctor and someone has an appointment with him this afternoon” – George Carlin
Continue reading What Do You Call The Guy Who Graduated At The Bottom Of His Class In Medical School?How Health Insurance Brokers Can Avoid Extinction & Earn Bigger Bucks
It’s tough being a health insurance broker these days. Fewer carriers to work with and the new pesky transparency law requiring commission disclosure is enough to drive one to drink……………….or voluntary benefits selling.
Continue reading How Health Insurance Brokers Can Avoid Extinction & Earn Bigger BucksBlue Cross CEO Suffers $1.2 Million Pay Cut
Blue Cross CEO saw pay cut to $15.7M amid jump in medical, pharmacy claims
JC Reindl – Detroit Free Press
The top executive at Blue Cross Blue Shield of Michigan took home slightly less pay last year as the insurance giant experienced an underwriting loss amid a 12% jump in medical and pharmacy claims, including growing cost pressure from popular weight-loss drugs like Ozempic.
Continue reading Blue Cross CEO Suffers $1.2 Million Pay CutNon-Compete Clauses Are Bullshit
Editor’s Note: Years ago, many years ago, I leased my services and talents to a major BUCA in return for a salary and benefits (I was labeled an “employee”). I was very good at sales and made the company a lot of money. Then six years later my client (The BUCA who paid me for my services and talents and who recognized me as an “employee”) asked me and all the other employees to sign a non-compete agreement. I refused. “Bill, if you don’t sign you will be terminated!” my boss said. “Ok, terminate me” I replied. They didn’t. Anyone who signs a non-compete is an idiot. BTW – NDA Agreements are Bullshit too.
Continue reading Non-Compete Clauses Are BullshitWhy Doctors Don’t Accept Health Insurance
Doctors who accept health insurance forfeit more than half their pay to do so through labor costs and fixed cost overhead.
Continue reading Why Doctors Don’t Accept Health InsuranceECISD Considers International Rx Sourcing
Start 38.15
Edinburg Independent School District’s insurance consultant discusses international sourcing of prescription drugs as a cost effective option to high cost American specialty drugs.
Continue reading ECISD Considers International Rx SourcingICHRA – A Game Changer
The newer generation of people you’re trying to recruit and retain want more choices and more say in selecting the benefits that fit them best.
Continue reading ICHRA – A Game ChangerTEXANS: Fight Up To $20,000 In Disputed Medical Charges In Small Claims Court – For Free
A Hospital Bullied a Mom With an Overpriced Medical Bill. She Bullied ‘Em Back.
“Sutter left Donovan with no other option. Thus, in early December, Donovan filed her claim in Superior Court of California for Alameda County: Leslie H Donovan v. Sutter Health Billing Department.”
Continue reading A Hospital Bullied a Mom With an Overpriced Medical Bill. She Bullied ‘Em Back.He Broke The Company Record By Selling 271 Policies In One Week
Taking a job as a door-to-door salesman for Combined Insurance the slick-talking salesman was a natural. He broke a company record by selling 271 policies in one week.
Continue reading He Broke The Company Record By Selling 271 Policies In One WeekMore Lloyds Of London History By Paul Miller
Double Indemnity is a 1944 thriller. It stars Barbara Stanwyck as a housewife who is accused of killing her husband for insurance money and a claims adjuster whose job is to investigate.
Continue reading More Lloyds Of London History By Paul MillerText Message From Former Client Is What Business Should Be All About
“I’m at a healthcare conference. Was talking to a presenter this morning about our health plan. He said we are progressive, so much so even most of the consultants here are behind us. A nice testament to the excellent work you did for us.”
Continue reading Text Message From Former Client Is What Business Should Be All AboutPaxlovid
CAPITATED PER LOCATION BENEFIT PROGRAM FOR HOURLY EMPLOYEES
THE PROBLEM
Competing for hourly workers is tough business. It’s a price war. Employees leave at the drop of a hat, chasing nickels and dimes, flipping burgers right down the street in plain view instead of serving your customers at a dime an hour less.
Continue reading CAPITATED PER LOCATION BENEFIT PROGRAM FOR HOURLY EMPLOYEESTexas Insurers Scramble After Drivers Learn About Hidden Rebates
TX Drivers :You may be eligible to receive a massive discount on your insurance. New rules greatly favor those who drive less than 50 miles/day, and insurers are scrambling as drivers learn about this. Those who live in qualified zip codes can get even larger discounts.
Continue reading Texas Insurers Scramble After Drivers Learn About Hidden RebatesPrimary Care Is Not Scalable
By Guy Culpepper MD
The supply of family physicians cannot be raised or lowered based upon yearly market fluctuations.
Continue reading Primary Care Is Not ScalableRoom Temperature Cardiologist Departs In Style
Name Redacted At Request Of Family
A prestigious cardiologist died last week and was given an elaborate funeral by the hospital he had worked for most of his life.
Continue reading Room Temperature Cardiologist Departs In StylePublic Employers Rx Spend Expected To Skyrocket
If you are a Public Organization with a self-funded plan it is expected you will be part of the 46% total expenditures of prescription public cost in 2024! The chart above shows changes in absolute spending, by payer.
Continue reading Public Employers Rx Spend Expected To SkyrocketOldest Hospital In North America
At the end of the Mexico-Tenochtitlan Conquest, Hernán Cortés began the construction of the hospital known as “El de la limpia Concepción de Nuestra Señora,” at the place where he had first met Moctezuma.
Continue reading Oldest Hospital In North AmericaDr. Thornhill Discovers Cure For Covid
2024 UnitedHealthcare Agent Bonus Plan Announced!
Blue Cross agent bonus program is limited to a measly $500,000. Aetna competes for the same brokers by offering an unlimited bonus program. Now we see United Healthcare matching Aetna’s unlimited bonus program with a program of their own.
Continue reading 2024 UnitedHealthcare Agent Bonus Plan Announced!Aetna Competes For Broker Loyalty
Blue Cross pays brokers a “Loyalty Bonus” of up to $500,000. Now we see Aetna competing for brokers with what appears to be an unlimited “Loyalty Bonus.”
Continue reading Aetna Competes For Broker LoyaltyAn Obvious Indication Of Why Health Care Costs Are High
By Julie Selesnick, Attorney
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. Here is reason Number #1: The #BUCA billions—this is what we are overpaying for—the billions raked in annually by UnitedHealth, CVS, Elevance, Cigna, Centene & all the other major carriers & PBMs.
Continue reading An Obvious Indication Of Why Health Care Costs Are HighThird Party Fees Add Up Fast
Paying health insurance claims is more than just paying providers. You’ve got to pay a whole lot of other people first and it’s adding up fast.
Continue reading Third Party Fees Add Up FastBlockbuster Weight-Loss Drugs Slashed From NC State Plan Over Ballooning Costs
The plan spent $102M on the weight-loss drugs last year, 10% of total drug costs.
Continue reading Blockbuster Weight-Loss Drugs Slashed From NC State Plan Over Ballooning CostsWhy See The Nurse When You Can See The Doctor?
“What brings you in today?” asks the admissions clerk. “What brings you in today asks the nurse?”
Continue reading Why See The Nurse When You Can See The Doctor?Independent PCP Considers Insurance Sales
In response to a previous blog posting (SEE POSTING HERE) we received an email from a primary care physician we know asking if insurance sales was an opportunity for him and “if so, how?”
“By Golly!” I thought, “He’s on to something!”
Continue reading Independent PCP Considers Insurance SalesEarn An Extra $500,000 Under BCBSTX 2024 Bonus Program
BCBSTX announces 2024 bonus program for individual and group sales……..
This bonus program is in addition to (and separate from) all other BCBSTX bonus programs. The maximum payout per contracted producer or agency is $500,000 per participating plan state.
Continue reading Earn An Extra $500,000 Under BCBSTX 2024 Bonus ProgramDentist Treats His First Patient
Newly minted dentist treats his first patient who is in immense pain.
Continue reading Dentist Treats His First PatientBeware Of Insurance Company Rats
Be aware whatever you tell your insurance company can be weaponized against you faster than a speeding bullet by armed politicians working against your vested interests.
Continue reading Beware Of Insurance Company RatsJaclyn Bjorklund Files Rotting-Food Stomach-Paralysis Lawsuit
Ozempic, Mounjaro makers hit with ‘stomach paralysis’ lawsuit
Stomachs remain full of days-old rotting food, which is unusual because less than 10% of food consumed is left in the stomach four hours after a meal
Continue reading Jaclyn Bjorklund Files Rotting-Food Stomach-Paralysis LawsuitMexRx
The UNITED STATES and some other countries require a prescription on all medications sold from Mexico. They further require documentation in English and an invoice of all medicines sold for customs. For these countries, Medicina Mexico is now delivering your medicines to Dr. Isaac Reyes, MD (Ced. Federal 644884) (Ced. Estatal 1537-02/05) along with the required documentation including documentation on each medication sold in English is from Wolters Kluwer.
Continue reading MexRxAttention Employers: At Home Workers Are Very Happy Employees
Generic Drugs Should Be Cheap, but Insurers Are Charging Thousands of Dollars for Them
Health insurers mark up prices of generics for cancer, multiple sclerosis and other complicated diseases
Continue reading Generic Drugs Should Be Cheap, but Insurers Are Charging Thousands of Dollars for ThemPharma CEOs Grilled By Senate
By Armando Polanco
Great read below on who sets the prices on prescriptions in the United States
Continue reading Pharma CEOs Grilled By SenateInsurance Office of America – An American Success Story
My first job was tossing coal into the fire at a steel mill in Pittsburgh, Pennsylvania. I worked hard and thought that, by being the most productive on the floor, it would create an opportunity to advance in the company.
Continue reading Insurance Office of America – An American Success StoryGovernment Pre-Cert Program Approves Cosmetic Surgery
Ever wonder what goes on behind the scenes of a pre-certification program wherein medical procedures are considered for approval?
Continue reading Government Pre-Cert Program Approves Cosmetic SurgeryTEE Group Insurance Program For Texas School Districts
Texans for Excellence in Education (TEE) and its partner, Insurance One, are in a “full court press” getting their insurance portfolio comprising 49 ISDs ready for the international market for the 2024-2025 school year.
Continue reading TEE Group Insurance Program For Texas School DistrictsSouth Texas Work Ethic: 83 Year Old Insurance Broker Still Going Strong
Mission State Farm insurance agent celebrates 50 years
Jerry thus began his insurance career in 1974, his first office four blocks from the agency’s current location, where Sweets by Kacy sits. He and his wife furnished the building with two lawn chairs and a chestnut-colored desk and got to work.
Continue reading South Texas Work Ethic: 83 Year Old Insurance Broker Still Going StrongStretchDollar’s Free ICHRA Platform
ICHRA Insurance brokerage works on commission only and does not charge fees to access their platform unlike other ICHRA vendors who charge as much as $30-$40 PEPM administration fees + commissions.
Continue reading StretchDollar’s Free ICHRA Platform15 Feb. 2024 TRS ActiveCare Board Meeting
Below are a few slides of interest for today’s today’s TRS ActiveCare board meeting:
Continue reading 15 Feb. 2024 TRS ActiveCare Board MeetingMiller’s History of Lloyds, A Continuing Series
By Paul Miller
It’s said that insurance cost Quentin Tarantino an Academy Award.
Continue reading Miller’s History of Lloyds, A Continuing SeriesUltrasound Technology For Pregnant Humans Deemed Obsolete
Public school educators moonlighting as medical diagnosticians are on track to save expecting parents across the country millions of dollars in sonogram and ultrasound testing services.
Continue reading Ultrasound Technology For Pregnant Humans Deemed ObsoleteDirect Primary Care Statistics
See how DPC physicians described their practices HERE.
Continue reading Direct Primary Care StatisticsThe Affordable Care Act Highlights Need for Actuarial Services
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 ServicesState 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 Duty