With obesity running rampant it would seem food insecurity affects very few these days. A quick visual confirms a majority of Americans have successfully solved food insecurity in this country. Those unfortunate few that haven’t are rejoicing with the news UHC is coming to the rescue……………
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Dogs and cats are happy today after the NAIC passed the Pet Insurance Model Act. Dogs are barking and cats are purring all across the Fruited Plains after hearing the news.
“Finally, we’re not subject to stringent pre-existing conditions” said Boudreaux Wilson the 3rd, a Blue Healer mix from Yoakum, Texas. “Are we gonna get government subsidies next?”
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While you were sleeping the government passed a new law which includes $64 billion to extend a policy under Obamacare to reduce health insurance costs. TRANSLATION: Government just gifted $64,000,000,000 to American health insurance companies to be disguised as “subsidies”, a politically correct term for “welfare payment.”
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Level funding is a form of self-funding that looks, acts, and feels like a fully-insured plan. It’s ideal for groups who have low risk tolerance and who want all the guarantees and safeguards of a fully-insured plan.
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Plan sponsors provide employees “health care expense accounts.” This is called health insurance. Like most company expense accounts there are stipulations employees must abide by.
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At Revive, we have a saying: “The patient will see you now.” That’s because we’ve created a solution that puts patients in charge of their care and addresses the current challenges of the health care system.
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As a physician, I agree with the majority of my peers who expect virtual primary care to surpass in-person care within five years…………………….
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Blue Cross of Alabama has been buying up small regional TPA’s and rebranding under the name 90 Degrees Benefits. Blue Cross of North Carolina owns a TPA too. Now we see more BCBS plans entering the TPA market. Here’s the latest……
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Level Funded Stop Loss insurance provides all the benefits of self-funding by retaining all unused funds, lower maximum costs, no lasers, and flexibility in plan design.
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By Doug Aldeen – ERISA Healthcare Attorney and General Counsel
95 million American earn less than $35,612 or 275 percent of the FPL. Why pay for anything other than DPC with a 501 r wrap?
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Alex Zuniga is an independent insurance broker / consultant in deep South Texas who doesn’t fit the mold. He’s different.
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“Come and get your copiers” says the City Manager. “But we have a five year contract!” says the vendor. “Doesn’t matter” says City Manager ……………………
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Our friendly drivers will pick you up, take you to your appointment, and then bring you back home – all in the comfort of our specialized vehicles. And we will deliver your prescriptions to your home at no cost to you.
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Level funded health plans are becoming a viable option to fully-insured plans. Radion Health has all the right selling buttons………………………..
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The economy must be thriving these days. Business must be booming. The nation’s largest employer whose revenue this coming year will break all previous records will be adding 87,000 new employees to their health plan.
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Remember Xerox? How about Eastman Kodak? Both were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before. Now we are seeing something similar in health care……………….
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By Patrick Moore on linkedin
If you’re a CFO or HR expert then you really need to hear me on this: You are now required to know how much money people are making off of your healthcare budget.
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Comprehensive
healthcare benefits with
nationwide access
We bring you transparent access with direct-pay medical providers who get paid at the time of service so the patient is not billed afterwards! Our comprehensive network of doctors, dentists, pharmacies, labs, and everything in between for a truly complete healthcare package.
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Everyone thinks size matters when purchasing employer sponsored medical insurance. It doesn’t
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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.
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First there was Continental Benefits. Then there was Marpai. Now there is……………………..
Marpai To Acquire Maestro Health
MyHealthGuide Source: PRNewswire, 8/4/2022
NEW YORK — Marpai, Inc., an AI-technology company transforming the $22 billion TPA market supporting self-funded employer health plans, announced it has signed a definitive agreement to acquire Maestro Health (“Maestro”), a leading TPA servicing over 80 self-insured employers, based in Chicago, Illinois.
A carved out custom fully insured prescription drug benefit plans for the large group health benefits marketplace? This is interesting. Will this lower the cost of drugs?
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In the N. Korean model, patients play an important role in the “pre-certification process” which is tied to a per admission “deductible” intended to speed up access to needed healthcare……………………
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“We’ve gone from fat acceptance to fat celebration. To view letting yourself go as a point of pride? The term body positivity is used to mean ‘I’m perfect the way I am because I’m me.’ It’s Orwellian.” – Bill Maher
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Legacy health insurance brokers are worthless. They’re bad for your financial health. They’re lazy, dumb and often great golfers.
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Here’s an opportunity for health insurance brokers to earn big bucks by simply forwarding this RFP to the four or five remaining fully insured carriers active in the market. Effortlessly, lift your index finger, gently tap the send button, and email the link below to your favorite BUCA rep. They’ll do the work while you play.
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By Christopher Chen, MD
Consider a typical primary care doctor who sees 30 patients a day, generating some $600,000 in a year ………………………..
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July 26, 2022 at 4:47 AM CDT
In 2021 alone, pharmaceutical firms provided a staggering $204 billion in price concessions for brand-name medicines–but the funds have mostly benefited insurers and their pharmacy benefits managers.
A federal court recently exposed the rot at the heart of America’s health care system.
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Retailers, payers and startups could capture 30% of primary care market by 2030: report
By Heather LandiAug 2, 2022 12:30pm
Bringing new care and reimbursement models to the market along with a bigger focus on virtual care, these nontraditional players are gaining traction and have the potential to grab as much as a third of the U.S. primary care market by 2030, according to a new report from Bain and Company.
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Emerging Leader Accelerates Growth Trajectory and Market Penetration
PONTE VEDRA BEACH, FL / ACCESSWIRE / August 3, 2022 / ReviveHealth™, Inc. has announced they have acquired ManifestRx™, an innovative national digital pharmacy services platform, as they continue their quest to become a preeminent leader in digital health whole-person care.
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The parents of Maddux Brown saved big when they learned that nonprofit hospitals are required to provide financial assistance. You and your loved ones could, too!
When 6-year-old Maddux Brown underwent a 15-minute surgical procedure his dad Jason didn’t expect the bill to empty his bank account.
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“If your PBM contract pricing includes AWP-X% you are getting screwed. If the contract also includes MAC pricing you’re getting doubly screwed” – Molly Mulebriar
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RiskManagers Blog has been down the last few days with readers getting the message “Access is not available on account of abusive activity.”
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Zelis Healthcare, backed by Parthenon Capital and Bain Capital, has agreed to acquire Payer Compass for roughly $180 million, sources familiar with the matter tell Axios.
Dr. Benjamin Clinton explains how the poorest school district in Texas solved health care………..
Blue Cross has given a small school district in deep South Texas a better deal than TRS ActiveCare with over 400,000 members………………. (more…)
By Bill Rusteberg
I’ve been dealing with hospital administrators since the 1970’s and during the years since little has changed. I know exactly what the hospital administer will say and do during the negotiation process, their tactics, including the traps they set for amateurs.
By Bill Rusteberg
Recently I was referred to a large medical group that was interested in learning more about how we help plan sponsors manage their employee health care needs. They were fully-insured with a BUCA and tired of double-digit rate increases year after year.
New England Journal of Medicine reports a transformational therapy has effectively cured the Royal Disease………..
Separating The Sheep From The Goats – Matthew 25:31–46
I have hated this business for a long time but I love being an outlaw helping companies escape the prevailing death spiral…………………………..
“Don’t bother doing something unless your radically different from the competition”– Richard Branson
By Bill Rusteberg
Building a Rx benefit plan without a PBM (Predatory Business Model) is beginning to make sense for plan sponsors whose Rx costs are as high as 50% of total plan spend. They no longer view their plan as a health plan but as a Rx plan with health benefits attached.
While chasing a squirrel in the woods, beloved pet dog tore the anterior cruciate ligament in her left knee. Turns out she had better insurance than her master………………………………
If Paul Harvey were alive today and had read the following article, he would have found fertile material for his “The Rest of The Story” radio show…………………………
Plan Sponsor Employs Discretionary Authority
Does your plan contain a discretionary authority provision? The government may be taking that away if HR 7740 passes. It will prohibit arbitration in ERISA claims and discretionary authority clauses.
Are PBM’s Adding Another Middleman To Avoid Transparency?
Are PBM’s creating another intermediary in the supply chain to prepare for transparency requirements? They stand to lose a lot if they get regulated on rebates. By creating another organization that’s offshore, they can protect their interests…………….
AUSTIN, TX – “He’s turning into a shell of his former self”, his wife cried.
Lee had become so frail that it took every ounce of energy just to hoist himself out of his scooter and into his favorite Lazy Boy.
Article Referred By Jody Bright
Pharmacists can now prescribe Paxlovid, Pfizer’s COVID-19 antiviral pill, directly to patients.
Prescription drugs don’t have to be as expensive as they are. A smart plan sponsor, thinking out of the box, would discover tremendous savings if they seize advantage of opportunities available in the free market.
“Pharmacy Benefit Managers are one of the three most influential opponents of price transparency……………….. If the true cost of a medication were known this would shine a light on the fraud taking place, so the PBMs hide the costs at every turn”
SOURCE: Vitori Health
Twenty years ago, nearly two-thirds of doctors were independent practitioners. Today, only one-quarter remain independent.
Once Upon A Time there was a young man in dire need of medical care but he had no insurance………….
Protecting patients,
health plans and insurers
across the U.S.
“We engaged Koehler-Fitzgerald in 2015 to represent covered employees of health plans we provide administration to that have adopted reference based pricing. They have been very responsive to the needs and questions presented by plan sponsors, plan members, and our staff. Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. Knowing that every participant has legal representation from a high quality, experienced law firm provides our client plans and employers confidence that their employees will be properly protected from the many aggressive balance billing practices that a small portion of hospitals and other medical providers attempt to employ. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.” – Jim Farley, J.P. Farley Corporation
A national poll conducted by the Molly Mulebriar organization found 99.99999% of Americans hate their health insurance. The primary reasons cited include affordability.
Asserta is offering investors an opportunity to share in a fast growing segment of the American health care system of finance providing employers significant savings on health insurance costs while removing financial barriers and improving member experience for working Americans ………………
Specialty Drugs Have Consequences
During the interview process Joe Sixpack learns the position pays $35,000 plus benefits. Little does the employer or Joe know the true cost was going to end up being $650,000…..the equivalent of 18 jobs………..so to keep from bankruptcy the employer must reduce his workforce by 18 (hopefully non-essential) employees and freeze wages for everyone else ………….or move his manufacturing business to China and his $685,000 per year employee to unemployment.
MyHealthGuide Source: Voya Health Solutions*, 7/5/2022
Voya Health Solutions* is pleased to announce their continued expansion into the mid-market beginning with quoting on July 1, 2022.
This blog entry is directed towards PBM experts who are not PBM’s or employed by a PBM. We are searching for the truth about the deep black vortex of the PBM world……………
“Reimbursements for overrides are taxable if not provided a written plan as required by Code Section 105. If taxable, reimbursements should be reported on employee W-2s and all applicable income and employment taxes should be withheld and reported as required by the IRS….”
“Pssst….Godfather, We’ve Been Exposed!
The following account is based on a true story.
If a Reference Based Pricing plan pays medical caregivers 120% of Medicare, what is the Plan Sponsor paying?
“Prudent plan fiduciaries will establish and adhere to a formal, written policy to ensure compliance with the New Disclosure Rule. Indemnification and limitation of liability provisions in service provider contracts should also be revisited relative to this new rule.”
Eagle Pass Independent School District has got to be paying more for health insurance than any other school district in Texas…………………..
By Doug Aldeen
Sunday morning bathroom read (Happy 4th of July): Slowly but surely (more like a glacial pace) the python like grip of the industrial medical sick complex is loosening… .
“Some things are worth getting mad about. The hospital cartel is using taxpayer dollars to help crush the middle class and rob lower-income families of upward mobility…………Wealthy hospitals took billions of taxpayer dollars meant to protect struggling hospitals — and then some billed poor families or even sued patients.” – State Treasurer Dale R. Folwell, CPA
Dogs are “superior smellers” and are already used to detect what the human nose typically cannot from diseases, such as Parkinson’s, cancer and diabetes, to drugs and explosives in public places, according to the American Lung Association.
California will become the first state to remove immigration status as a barrier to health care, making all low-income illegals eligible for state-subsidized healthcare regardless of age.
4 Out Of 5 Americans With Diabetes Went Into Debt To Pay For Insulin, New Survey Shows
By Deb Gordon
Amidst rising inflation, Americans are feeling the squeeze of higher prices on everything from gas to groceries. But when inflation bumps into the already rising cost of drugs such as insulin, the impact can be serious and the stakes are high.
Amazon is acquiring One Medical for $18 a share, an all-cash deal that values the primary health-care provider at roughly $3.9 billion, the companies 
