Fee-for-Service Primary Care Only Pays $60 – $140 Per Visit. However, Primary Care Has Been Shown to Decrease Hospitalizations by 20%… Saving $50,000 Per Hospitalization.

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Texas House Bill 1941 was introduced this month because some believe Elephant Lives Matter…………

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If PPO’s are supposed to save us money on health care why hasn’t it? We all agree forty years of managed care hasn’t worked so why are we still hoping it will?

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You can’t make this stuff up………………………..

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Thank you for your (pick one) EMAIL. VOICEMAIL……….…………

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“If you went to Denver, Dallas, OKC or ABQ you would not find a better benefits consultant. Very helpful and knowledgeable. Out of the box thinking.” – Alan, Ideacom

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There is yet another vendor offering Texas educators a TRS ActiveCare alternative strategy which is (drum roll please)…………………….

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Texas school district makes a one time gift of $12,000,000 to be split between employees and Uncle Sam in an effort to bribe employees from leaving for greener pastures. This is the same district that closed down schools last year and laid off workers due to rising health insurance costs.

Would it have been better to fund a Health Savings Account for all employees instead? Of course Uncle Sam would get nothing in that case while the employees would gain ownership of the entire $12,000,000 gift, tax free, forever………………

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This photograph from 1921 shows Millicent Woodward, a lady who took out a policy at Lloyd’s of London that year.

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Last week we witnessed an idiot burn down a bridge. Fire department investigators reported the bridge beyond repair.

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“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson

Public Consulting Group’s (PCG) Texas ISD HealthPlan is an innovative, new healthcare program designed specifically for Texas Independent School Districts (ISDs), Texas teachers, and their covered family members.

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“Don’t go near those who have had the COVID vaccine,”  warned the official,  “They have become …………!”

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Molly Mulebriar, investigative reporter from Warring, Texas, is currently winding up her investigative report of a Texas TPA’s efforts to boycott a competitor in violation of the Texas Insurance Code.

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A lot has changed since I entered the world of health care benefits in 1973. The journey has been fascinating………………

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Relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans……………….

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Doug Aldeen – RBP Defender Warrior

Doug Aldeen (The Magnificent), an ERISA attorney, talks about Reference Based Pricing and what he does to help plan sponsors in that space. This is a guy you want in your corner……………….

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Relating to bids or proposals required for insurance and risk pool contracts entered into by a school district, municipality, or county.

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Lawsuit accuses the health insurance agency of trying to defraud the district……..This impoverished Texas school district is a plaintiff’s lawyer’s dream come true……………lawsuits fly left and right over the past decade……………..Meanwhile back in the classroom……………..

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A school district in deep South Texas was paying their benefits consultant $614,000 per year but didn’t know it.

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Relating to registration and annual filing requirements for governmental units establishing a self-insurance fund.

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People React With Joy At The News

“Insurance plays an important role in realizing the politics of love for the people.”

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“To collect test samples, the swab needs to be inserted about three to five centimeters (1.2 to 2 inches) into the rectum and rotated several times………….”

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Engage, Pay Less, Get Rewarded………………………..

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House Bill 1490 would require Texas hospitals to post cash prices for their services……….

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In order to protect TRS ActiveCare, the Committee on Pensions, Investments, & Financial Services recommended in their interim charges that the 87th Texas Legislature take action to “explicitly prohibit independent school districts from using District of Innovation status (as) a method for opting out of TRS-ActiveCare.”
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“He who has data wins. He who has good date wins a lot. He who has real time data wins all the time.” – Author Unknown

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As  some of you in our space may be aware we have recently noticed Tenent is aggressively going after RBP accounts across the country seeking the difference between billed charges and plan allowable despite accepting RBP patients, taking an Assignment of Benefits, and cashing benefit checks.

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Amazon knows robots don’t need health insurance but people do. A robot can be programed to do what people do while people can’t ever be programed to perform flawlessly time and time again. Robots are never late for work, never complain, don’t steal, and work tirelessly 24/7.

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The Texas legislature meets biannually and is now in session. Here are three bills worth watching……

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 Simone Gold, M.D.

Simone speaks the truth about the Wuhan virus (politically correct term is Covid-19 – we don’t want to offend the Chinese do we?)

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Texas school district saves $530,457 by replacing their health insurance Agent of Record after previously awarding her $1.8 million plus an 8 year contract worth +$60,000 per month.

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The Bang Bang Health Plan

An Arizona county employee benefit plan has found a way to effectively turn a $3,500 employee health benefit into a $25,000 equivalent by crossing a manmade line in the desert………………. (more…)

It’s been less than 24 hours from yesterday and noise from Washington suggests changes in the way American healthcare is financed and delivered may be imminent………..

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The price of diabetes related medicines should be an American embarrassment……………

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Texas insurance agent stands to gain $68,375.00 per month for the remainder of the original term of the agreement if her eight year  consulting / brokerage agreement with a Texas public school district is canceled for “any reason.” 

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If passed, this could make ICHRA’s even more attractive to employers who are tired and fed up with all the hassles of providing group health insurance for their employees along with the ever present threat of punishing government sanctions. 

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If Texas House Bill 573 passes this legislative session Health Care Sharing Ministries will be prohibited from certain advertising such as touting their financial strength and past performance to provide health care benefits for their members…………… even if its true!

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TEXAS HEALTH INSURANCE BROKER

Texas health insurance brokers who find themselves in the unemployment line by way of passage of HB 602 will be able to retrain for other careers through state provided funding. 

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Medical discounts are a scheme used by health insurance companies, service providers, hospitals, and others in the medical supply chain to show “value” to their customers. “Look at how much we saved you! Aren’t you happy you choose us as your partner! Just imagine what you would have paid without us!”

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MultiPlan Corporation to Acquire HST

• Accelerates Growth by Adding a Next-Generation Reference-Based Pricing Program to the MultiPlan Solution Suite
• Acquisition is the First Under MultiPlan’s Enhance-Extend-Expand Strategy
• Increases Value for Customers by Adding New and Complementary Services to Better Manage Cost
• Deepens MultiPlan’s Penetration in the TPA/Broker Segment

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All across the nation, cities big and small are having their pockets picked and their communities decimated by their local nonprofit hospitals.

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Fear of public toilets is nothing new and surprisingly common. But is COVID by toilet really a thing?

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By Molly Mulebriar

Third party administrators (TPAs)  have always enjoyed the power of incumbency and it has never been greater than now.

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The Mark Cuban Cost Plus Drug Company is dedicated to producing low-cost versions of high-cost generic drugs. We pledge to provide radical transparency in how we price our drugs.

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China’s Communist party rolls out pilot tax benefit plan in hopes to expand private health insurance because the government’s plan is not good enough…………….

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Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the San Antonio community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.

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Cameron County is seeking a qualified fee based insurance consultant to assist the county in a competitive RFP process for group health insurance for county employees. 

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Wanna hear about the broker who was making $614,000 on a South Texas 2,500 life school district while the clueless Board of Trustees thought the compensation was $128,000?.

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Politicians Chase Dollars To Remain In Power

Blue Cross, punching down, has announced they will no longer share member’s premium dollars with lawmakers except for those who pledged allegiance to Joe Biden…………….

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Healthcare isn’t expensive. It’s price-gouging and profiteering that is expensive and straightforward to eliminate………………..

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If hospitals are required to publish their prices and they have patients sign agreements wherein the patient agrees to pay “in accordance with the regular rates and terms of the hospital” which are public for the world to see, what defense does the patient, who assigned benefits, have in disputing full billed charges when the average reimbursement accepted through the hospital’s payer mix is substantially less?

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An adhesion contract (also called a “standard form contract” or a “boilerplate contract“) is a contract that heavily restricts one party while leaving the other free (as some standard form printed contracts); implies inequality in bargaining power

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The Gang Disbands

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

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All health care is local, or at least it ought to be………………….So why do most plan sponsors hire out-of -state plan management firms like UHC, Humana and the rest? They just get in the way…………………..

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This is one of Dr. Bricker’s best videos. In 7 minutes he puts the current economic status of healthcare in historical perspective.

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Effective in 2021, employee benefit plan fiduciaries will be required to get fee disclosures from service providers…………..this means hidden fees earned by many brokers (especially the large national brokerages) must be disclosed to newly horrified plan sponsors

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Traditional PBM Representative Reacts 

In 2011 when the Employers’ Advanced Cooperative on Healthcare founded Employers’ ChoiceRx (ECRx) it was the first pharmacy BENEFIT solution built to be a transparent/cost-plus program that focused on “therapeutic equivalent” drugs to achieve a lowest net cost reference price.

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Approved cardholders receive immediate access a revolving credit line of up to $30,000 to pay for covered health care expenses……………….

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“The pharmacy benefit managers are not going to like what we are doing when it comes to ScriptCo.”

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Districts of Innovation offering competing health plans have impacted TRS membership this year. Market intelligence tells us one of the new competing health plans has captured approximately 12,000 employee lives with a total of 17,000 members………….

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Lone Ranger Rejoices – No More Mask!

Researchers from Tel Aviv University have proven that the Chinese Flu virus can be killed efficiently, quickly and cheaply using ultraviolet light-emitting diodes……..all in 30 seconds…………

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In-sur-ance (in-shoor’ens) n. 1.a. The act, business, or means of insuring persons or property. b. The state of being insured. 2. A contract binding a company to indemnify an insured party against specified loss. 3. The sum of which something is insured. 4. RiskManagers

Insure (in-shoor’) v. – sured, -suring. 1. To protect against loss, damage, etc. with insurance. 2.  Also ensure (en-). To insure n. RiskManagers

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Hospitals Hate Pricing Transparency

Hospitals failing to comply will be subject to a chump change fine not to exceed $300 per day ($109,500 per year). Plus the government will attempt to embarrass non-complying hospitals by posting notice of the penalty on the government’s CMS website for all the world to see and marvel……..

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Why would any provider want to be in-network if they know they will always get more than what a plan pays?

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Andrew Jackson – Champion of The Common Man

After years of being stymied by well-funded interests, Congress has agreed to ban one of the most costly and exasperating practices in medicine: surprise medical bills……………

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