Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.

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“Will my doctor accept our insurance” ….………… “Yes, unless he’s an idiot.” 

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Learn a foreign language in the comfort of your home! You will be glad you did! Never again scratch your head and wonder what the heck that health insurance salesman was trying to convey during those dreadful renewal meetings. Stop relying on body language! Become empowered NOW!

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There is no doubt catastrophic claims are on the rise. Turbo-charged hospital bills reach the ever present stop loss outlier provision (common to most managed care contracts) faster than a melting Raspa in deep South Texas on a hot day in August.

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Hello Americans. I’m Paul Harvey. You know what the news is —– in a minute you’re going to hear the rest of the story……………………..

At 20 years old Eric started a hospital charity to benefit children in need of health care. It was a noble endeavor. In less than 10 years, he raised more than $20 million for terminally ill children at Saint Jude Children’s Research Hospital in New York. His charity maintained just over a 9 percent cumulative expense ratio, one of the lowest expense ratios of any charity in the nation, and funded the construction of one of the most cutting edge intensive care units and surgery centers dedicated to children.

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Raising drug prices is “a moral requirement,” says Nostrum Labs CEO.

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Many hospitals are more interested in extracting money from vulnerable patients than providing quality care at a fair price………………but greedy healthcare participants like hospitals don’t have quite as much leverage as they’d like us to think………………..

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Your BCBS renewal could be the beneficiary of a reserve buy-down in 2020 which means lower than normal rate increases. New business rates should be below market too. That’s because “A $1.7 billion tax refund under the Trump administration’s tax cuts drove a 226 percent rise in net income to $4.1 billion, from $1.3 billion the year earlier.” 

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By Molly Mulebriar

There appears to be some confusion these days as to rightful owner of the title God Father of Reference Based Pricing.  

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Texas Department of Insurance estimates that Aliera has about 17,000 customers in Texas and 100,000 nationwide.

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“The patient spent 1 hour in the OR.  I kid you not, the facility billed $153,887……….”

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“Over the past few weeks, several articles and “studies” have been filled with inaccuracies and, at best, incomplete analyses of Parkview Health’s financial position, with calls to invest more in the community. I never expected having to defend what Parkview does for the community, but I will, and I’ll also provide some context regarding our financials.”

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“Americans usually put relationships ahead of money” because the money is not really theirs. “Once patients find a physician they trust and a hospital they like, they tend to stick with them even if there is a lower-cost alternative nearby” because, after all, they use Other People’s Money. No one ever cares about health care costs when using Other People’s Money (insurance). Transparency be damned………………………

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By Molly Mulebriar

How many times has an employer said to you “Yes, we ARE having issues with our TPA, but changing to another one is too disruptive and challenging. Plus, we are out of time since our renewal is just around the corner. We are just going to stay put for now and live with it.” (more…)

A $3,935 cover charge? No problem! I’ve got Nightclub Insurance! Let’s party………..

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By Carl C. Schuessler, Jr., DHP, DIA, GBDS

Organized crime – this is killing diabetics…………………

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Do retail pharmacies make more or less money through PBM contracts?  If they make less money is it to a point they lose money?  Or do they profit? Before asking your pharmacist, try this experiment first.

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Founded in 1983, BAS is a results-driven third party administrator with a track record of delivering cost savings and customer satisfaction. We utilize our services, tools, and partners to create a robust partially self-funded plan as unique as each client.

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UnitedHealth Group Inc. will lose two large customers in its retiree health-care business next year, a setback for the insurer in an increasingly competitive marketplace for senior medical benefits.

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Formerly sleepy TRS trustees are considering “big changes” to TRS ActiveCare because member districts are threatening to leave to establish their own health plans. Competition, for the first time, is clearly at play here (Texas School District Challenges TRS ActiveCare Plan Mandates).

The TRS solution? Eliminate community rating so some districts can pay more and utilize narrow networks so all districts have less choice……………………..

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Lord Roberts -Protector & Defender of ObamaCare

“In court in July, only two of the three judges … asked questions. ‘Oral argument in front of the circuit went about as badly for the defenders of the [ACA] as it could have gone,’ says Nicholas Bagley, a professor of law at the University of Michigan.

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Specialty drugs can cost hundreds of thousands of dollars per member per year, or more. One new specialty drug approved this year costs +$2,000,000 for an annual treatment………

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Carl Schuessler is set to speak at the upcoming Texas Public Policy Foundation event in January, 2020 in Austin, Texas. The panel discussion is on “The Way Out of America’s Broken Health Insurance System.” Knowing Carl as we do, his message may be “Grow Cojones For (a) Change.”

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We have reached a tipping point in the battle against high cost health care. Employers have run out of money to pay for it. Employees can’t afford to use their health insurance anymore. Meanwhile hospitals continue to game the system with egregious charge-master pricing and their disco-discount game with their carrier partners. They have effectively dug their grave and are about to be pushed into it……………..

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Proposal will take Colorado down several relatively untraveled roads, potentially creating a health insurance market like no other in the country that could become a national model — or a cautionary tale……………..

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Earning commissions forever by simply making an introduction beats working for a living………….

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A team of Jerusalem-based researchers and entrepreneurs claim they have a cure for diabetes that could hit the market as early as within the next few years…………..The patient should never have to inject insulin into his body again………………

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AMPS saw significant growth in its large customer portfolio this year, including customers with upwards of 150,000 members. The growth from small to midsize to large customers reflects broad embrace by employers and health systems……………..

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The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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 An idea with bi-partisan support?

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Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….

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According to one source, Hartford Life Insurance estimated that one-quarter of all Fortune 500 companies have COLI policies, which cover the lives of about 5 million employees.

Can proceeds go to reduce GASB 45 ?

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SOURCE: Trucker Huss

“The chief advantage of offering an ICHRA as opposed to traditional employer-sponsored group health plan coverage is that it transfers much of the financial risk from the employer to the individual marketplace, thus allowing for more predictable costs for the employer from year to year…….

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Indiana Jones (Michael Hicks) Sounds Alarm

“What I discovered will deeply anger every Hoosier and should embarrass most hospital administrators and board members. I also expect it to cause significant changes to state policy with respect to these hospitals. This is likely to change the way we tax them, regulate their competitors and enforce anti-trust laws. It will surely lead to civil litigation involving billions of dollars of excess profits.”

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Hospitals say price transparency won’t lower prices. So what will? 

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Advanced Medical Pricing Solutions (AMPS), the pioneer in cost containment for the self-insurance industry, announced a comprehensive cost containment solutions suite that will help self-funded employers significantly control healthcare costs in 2020……………..

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A new government approved group health plan through which employees may purchase individual health insurance on the open market may have a significant impact in the employee benefits arena.

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Centers for Medicare & Medicaid Services Administrator Seema Verma warned insurers to shape up or face the consequences of “Medicare for All.” 

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“El Paso ISD found a novel way to migrate most of its staff out of the state’s program and onto a new local plan…………In response to El Paso’s decision and with the expectation that other districts may pursue a similar course of action, TRS is now looking into the possibility of regional options for school district employees.” (more…)

General Motors cuts health plan for 50,000 striking employees

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A “revolutionary” new class of cancer drug that can treat a wide range of tumours has been approved for use in Europe for the first time.

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By Jeanne Pinder

We’re live with CBS national news! We’ve been promising big news for a while now, and here it is…….

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Cash payment claim strategies often saves more than what the plan would have otherwise paid proving providers will accept less reimbursement for cash………………..

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Freedom Health 100 is proud to announce a new group health insurance product  – The Freedom Health 100 plan.

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You never know who is behind the insurance curtain. You may think you have insurance with ABC Insurance Company,  but they may only be the “fronting” company retaining only a small portion of the risk. You might be insured with 20 or 30 carriers through a reinsurance treaty, each sharing in the risk on a prorata basis. 

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You’re negotiation skills suck!

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“They are using our money, so overpaying there is no consequence to them………So it is easier for them to pay the bills as they come in, whether they are appropriate or not……………..”

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By Bill Rusteberg

School districts are entitlement based bastions whose decision making processes heavily weight social considerations at the expense of prudent business practices.

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Every senator, virtually every congressman and every mayor of every large city has a powerful hospital system in his or her district. And those hospitals are as politically untouchable as soybean growers in Iowa or oil producers in Texas.

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Recent court decision is a reminder that health plan fees must be monitored and that a good fiduciary process is always the principal defense to claims of fiduciary imprudence.

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The job pays $65,000 per year plus benefits. By the time we add up all the benefits including health insurance, workers compensation, FICA, etc., your job is worth $85,000.

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By Bill Rusteberg

A favorite strategy to lower health care costs by plan sponsors is to change the logo on one’s I.D. card.  Everything else remains essentially the same.

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Brownsville and Harlingen in deep South Texas leads the country in the highest health care costs with a markup rate of 940% of Medicare, followed by three other nearby cities of McAllen, Edinburgh and Mission……………..

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“In the real market, healthcare costs are flat.” – Dave Chase.

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You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?”

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By MATTHEW HAHN, MD | POLICY |

What happens when you place an entire nation’s health care in the hands of an overly-controlling, ineffective government bureaucracy and huge corporations whose mission it is to squeeze as much money from the system, no matter the cost, including people’s lives? You get the carnage that is the American health care system.

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Medical trend continues to outpace general inflation. Those plan sponsors who abide by the law of civil obedience continue to fund the health care beast’s insatiable appetite while others are taking a different approach. The later have solved health care……….they have stopped feeding the beast…………

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By Molly Mulebriar

There is only one proven method to control specialty drug costs……… 

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A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit. Balance billing occurs when you don’t ask the price……………

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The State of Texas has filed a lawsuit seeking to stop Aliera Healthcare from selling health insurance in Texas and engaging in the business of insurance without a state license.

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More than 50% of doctors are now in employee positions and generally beholden to “big medicine” so that doctors’ fidelity is primarily to the hospital system that employs them and away from patients.

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By Bill Rusteberg

Mr. Sidgwick: “Self insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this an essential health benefit under the ACA?”

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For a free copy of Dave Chase’s best seller go here: healthrosetta.org/friends/

Great leadership, great students……………..

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A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital……

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The law limits co-payments for a 30-day supply of the life-saving drug under private insurance plans to $100. It does not change the price of insulin…………………

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Blue Cross has successfully hijacked the term Reference Based Pricing  –  a damn smart marketing move……………………

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A mid-size Texas employer went from a BUCA to a Reference Based Pricing plan last year. The benefits remained the same. However, a change was made in the way providers are paid.  In lieu of paying through secretive managed care contracts, the plan paid medical providers based upon a transparent reimbursement schedule tied to a percentage of Medicare allowable charges.

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“There are three possible ways for providers to avoid application of the anti-assignment provisions in plan documents.

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“Managing health care on a local level brings needed accountability to health care financing while providing improved access to care and higher patient satisfaction. The patient-physician relationship becomes more than just a ten-minute office visit; it becomes a true partnership.”  – Alex Zuniga

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Will HRA’s replace group medical plans?

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Is it true a South Texas Hospital system is buying up primary care practices to fatten up their cash cow?

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For many people in medical debt, a trip to the emergency room leads to the courtroom

Wenzle Hufford, 76, uses a rope to tow his wife, Lucynda, with his motorized wheelchair in Kennett, Mo. Both have large medical debts. His legs were damaged when he was hit by a car; she has diabetes and heart problems. (Michael S. Williamson/The Washington Post)

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By Bill Rusteberg

As members of the +400,000 member TRS ActiveCare risk pool “The Power of Large Numbers” and “Economies of Scale” bring comfort to small Texas school districts . “We could not get comparable coverage on our own, much less at affordable rates” is the mind thought of school district officials throughout the state.

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