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Beware of Insurance Consultants Dress In Orange…………………

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Former high school coach makes fortune in the insurance industry……………………….

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Texas school superintendent’s $2.25 million buyout threatens district’s finances………………..(Pssst…file this under Poor Risk Managment)

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Rising Health Insurance Rates………..Cost Shifting To Plan Members……………Less Choice

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GROUP HEALTH, DENTAL & EMPLOYEE BENEFITS INSURANCE CONSULTING SERVICES

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CalPERS approved steep rate hikes for its cheapest health insurance plans Tuesday in an effort to save its most expensive plans from collapse…………….price hikes of up to 51% for health plans favored by young, healthy workers

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  Retail Pharmacist Reacts To The News

“Members could save up to 80 percent on generics and 40 percent on brand-name medications when paying without insurance, according to Amazon.”

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Is your school district considering offering self-funded health plans to your employees? This document outlines things to consider when making this decision.”

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The upcoming Texas legislative biennial session is fast approaching and lawmakers will have to address an historic $4.6 billion budget shortfall. “Tell all departments to be prepared to cut their budgets another 5%”  dominates the Austin rumor mill these days. 

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An innovative and disruptive model designed to turn the industry on its head……….model has been shown to reduce health costs for their members by up to 40%…………members can customize the coverage to their individual needs…………..3 year rate guarantee in certain states…………Insured by

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Individual coverage health reimbursement arrangements (ICHRAs), a new employer-sponsored health care benefit program for active employees that became available this year, are drawing the attention of U.S. employers, particularly wholesale and retail employers and those in education and the public sector.

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He saved the ACA in 2012 by declaring the individual mandate essential to the survival of Act and then may save the ACA again in 2020 by declaring that the individual mandate is not essential to the survival of the Act……………………….

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City terminates UHC and enters into direct contract with local hospital system for significant savings…..

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TRADITIONAL REFERENCE BASED PRICING VENDOR REACTS TO NEWS

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

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Premiums can be 20% to 25% less for level funded plans than comparable community-rated plans………….An employer’s savings depend on the health of its employees and their families because an LFP plan is underwritten only for the specific employer’s employee population and not for a broader community.

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MyHealthGuide Source: GuideWell Mutual Holding Corporation via PRNewswire, 11/6/2020

JACKSONVILLE, FL — GuideWell Mutual Holding Corporation (GuideWell), the parent to a family of forward-thinking companies focused on transforming health care, announced that they have signed a definitive agreement to acquire WebTPA, an innovative and market leading administrator of self-funded employer health plans.

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SOURCE: Excerpt from Dave Chase ( Chapter 1: The Future of Health Will Be Local, Open and Independent – Relocalizing Health)

Bryan Perry, and direct primary care veteran, Clint Flanagan, have teamed up to serve employers such as the Bennett School District to reduce spending by ~50% while improving benefits.

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We hope you are keeping well, and keeping your distance. Please join us for a virtual chapter meeting… Wednesday, November 11 11:30am-1:00pm The Zoom invitation is below. You can open this invitation in a browser window, or directly from the Zoom app on your computer or device. We will discuss updates on meetings and general information about the free market. We are graciously requesting each member invite at least one person, either a Provider or Purchaser you think would benefit from FMMA membership. Examples would be: employer you know, especially self-insured interested provider broker/consultant local govt HR purchaser or even politician/policy maker It is mutually beneficial for all of us to share in growing the chapter and the movement. We look forward to seeing you … Thank you.

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Today’s election is historic…………………..and may fundamentally change health care financing…………… (more…)

SOURCE: HR Policy Association

“The final rule requires employers to have their third-party administrators publicly disclose detailed health care pricing data. It also mandates that employers make available to health plan participants an internet-based self-service tool that provides price and personalized out-of-pocket cost information.

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SOURCE: Health Affairs Blog

“Insurer stakeholders quickly panned the new rule, arguing that it is unnecessary and will lead to higher (not lower) health care prices.

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I was stunned,” said Fairly, CEO of The Fairly Group in Amarillo, Texas. “It was the first time in my 25 years that a program which was agreed and bound was nixed 12 hours before it was to go live.”

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The Texas Attorney General has been asked to determine whether the Texas Business & Commerce Code prohibits a consumer reporting agency from reporting certain information if a member is covered through a self-funded reference-based-pricing health & welfare plan.

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$0 Copays & NO Deductibles……………………………………

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I wrote this book to empower every individual — and to help everyone recognize that despite yet another season of campaign promises, we do not need to wait on our legislators in Washington D.C. to change health care……………………

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This graph represents the dynamics characteristic of traditional managed care plans (PPO). PPO contracts are tied to the billed charges, not costs. As billed charges go up each year, so do premiums, even though costs may have not gone up at all. Employers mitigate their increasing costs by reducing benefits. It’s a vicious never ending cycle.

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The Shoot Out At The OK Corral is an entertaining novella worth watching. Three insurance consultants vie for the business, each giving a 15 minute presentation to the Board of Trustees at the Kingsville Independent School District last week.

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“I’ll Never Retire………………………………………”

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“The intent of this notice is to make you aware that we don’t recognize in any of these programs and Baptist Health will not agree to accept unilateral rates established by these reference based pricing plans…………..plan participants may be held financially responsible for up to 100% of billed charges”

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Dennis was a witness to Texas history that few know about……………….

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“Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the flu.

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“We see a lot of brokers making significant efforts to pull in better loss information and better claims information so they can be partners in risk with their customers, in terms of explaining to them the patterns they see, benchmarking them against peers, and then being able to say: ‘If you do this, this, and this, your total cost of risk might in fact go down, and could go down significantly.”

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“It’s not the doctors, or the nurses, or the people that actually work,” said Butler. “It’s the system. It’s the billing system that they all operate under.” – Josh Butler

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Kingsville ISD went to bid for an insurance consultant to assist the district in managing their self-funded health plan. Staff made a recommendation to award the bid but the board decided to table action pending a public workshop. Three insurance consultants are bidding for the job.

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Specialty drug approvals, emerging gene therapies, less relevant PPO discounts, double digit higher charge master rates in 2021, more aggressive billing practices and COBRA provisions related to the pandemic will impact rates well into the coming year.

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Open enrollment is November 1, 2020, and ends December 15, 2020.

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Kent Sullivan has notified Governor Abbott that he will resign as Texas Insurance Commissioner in September to return to the private sector.

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Governor Greg Abbott today announced that Texas’ major health insurers have agreed to continue reimbursing network health care providers for telehealth appointments at the same rate which they pay for office visits through the end of 2020………………..

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A recent post on this blog, Low Bid Gets The Business, described the Kingsville ISD’s search for an insurance consultant.

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Holy Smoke! Insurance brokers can do much better with this compensation schedule ……………up to +3.5% better than current average commission levels……………………………

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Busy Jill – She Had 18 Children In Less Than 10 Years

Not too many plan sponsors have ever conducted health plan dependent eligibility audits leaving them at risk of stop loss claim denials. If Little Johnny is the covered employee’s nephew, with the same last name, has a stop loss claim you can rest assured the stop loss carrier will determine they are not at risk leaving the plan sponsor eating the entire claim……………A ticking time bomb waiting to happen…………….

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Dallas Area Rapid Transit is a transit agency serving the Dallas–Fort Worth metroplex of Texas. It operates buses, light rail, commuter rail, and high-occupancy vehicle lanes in Dallas and twelve of its suburbs. Wikipedia

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“First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools.”

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Twin brothers invented Opopira, considered a miracle drug back in the day, a pasty mass consisting of a drug mixed with sugar and water or honey suitable for oral administration. This complex compound drug was used to treat diverse maladies including paralysis. 

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Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..

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Once upon a time there was no such thing as a PBM…………………….

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“Healthcare is the only expense line item in which all employees receive an unlimited budget…and also no training in how to spend it. That’s why they sign up for $2500 procedures when a $75 solution would do the trick.”  – Dave Chase

 “When the patient gets the bill, it looks like the insurer haggled on their behalf. Yet the final charge is still much higher than it should have been. The patient loses, while the insurer and provider win.” – Nikki Haley

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Trolling the internet on Chinese Flu quarantine day # 267 (and counting) we came across a website touting “Free Rx.” As we suspected, it was just another third party intermediary offering to assist consumers in applying for Rx manufacturer assistance programs. For a fee of course.

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Health Care:

We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.

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What are the statistics for TRS plan year 2020-2021? How many employees have moved over to heretofore illegal, competing commercial health plans and away from the state sponsored TRS ActiveCare government plan? What is the financial impact?

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Single payer system by 2028? Will Republicans embrace Obama Care as the better of two evils? Will whatever the Supreme Court decides have little effect on political realities?

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After talking with The Tyler (Grow Some Balls) Rose, Charlie was convinced he could achieve his goal of creating a better health plan — one his 150 employees deserved……………

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I’ve been hard at work on something I’m very proud of: a roadmap for communities, large and small, to restore hope, health and well-being.

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Beginning an initial dialog with “How much will you charge us” is never a good indication things will go well with your chances of gaining a new client as long as pricing is the driving consideration.

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RAND stokes hospital pricing transparency fire with new report

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Angie Stewart – Friday, January 10th, 2020

Eye and gastroenterology procedures are some of the most common services proliferated in ASCs, according to a March 2019 report by the Medicare Payment Advisory Commission.

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Freedom from high drug prices…………………………………..

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Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!

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The future of healthcare will be decided via the ballot box, court rooms, and congressional halls.

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Love Boat Cruise Spawns MGU……………………………

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Austin Startup Sana Benefits Raises $20.8M to Provides Self-funded Health Insurance to Small Businesses

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Austin-based health insurance startup Decent has raised $10 million as it looks to expand statewide.

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For Fairly, the real story – and challenge– is not about insurance markets; rather it is about risk management.

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With Bind, costs and choices are transparent and easy to compare. There is no deductible or coinsurance to meet before the plan starts contributing, and members can change and shape their coverage as their health needs change.

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If you had a group of employees traveling on a business trip and you told them they’d only need to pay a $100 contribution toward the hotel room, what’s to stop them from choosing a Ritz Carlton over a Days Inn? Both provide a decent night’s sleep, but one will cost you, the employer, a significant amount more.

This is what manufacturing firms are doing now with their benefit plans

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“Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.

“Holy Smoke guys, we’ve singled out our cheapest providers,  much cheaper than all the others,  20% cheaper! We call it the  I-35 Performance Network.” says the Aetna rep.

“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”

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“I Was Raised To Pay My Debts On Time…………..”

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