Aldeen’s Sunday Morning Bathroom Read (ASO Fiduciary Plan Design 101/Bart Simpson Chalkboard)

A recent review of an Aetna ASO Agreement between a county and Aetna revealed the following provision:

“ASO rates are guaranteed until 10/1/23. If County changes medical and or pharmacy vendors in 2022, all unpaid pharmacy rebates from Aetna will be forfeited.”

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Dear Father, I’m Glad You’re Dead

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

Dear Father, Hope you and Mother are doing well since you left many years ago. Others have joined you since and I will too as soon as God allows. I’m happy you and Mother are dead as times have changed and you would be greatly disappointed if you were to come back for a day and read today’s paper as you used to do during your lunch break, coming home for a sandwich and a cold glass of beer in our sitting room while listening to the farm report on Channel 4. I’m glad you’re dead so you won’t have to live this and wonder what’s to come next. Your daughter and I will never forgo the values you and Mother instilled in us as we grew up. I still say “Sir” and fly the American flag in our front yard every day. Rest in Peace Dad!

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Judy

Judy, a purebred pointer, was the mascot of several ships in the Pacific, and was captured by the Japanese in 1942 and taken to a prison camp.

There she met Aircraftsman Frank Williams, who shared his small portion of rice with her. Judy raised morale in the POW camp, and also barked when poisonous snakes, crocodiles or even tigers approached the prisoners.

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Carl Schuessler To Speak At Direct Primary Care Nuts & Bolts to 2.0 Conference

You don’t want to miss this one! Schuessler knows how to rock an audience and get his message across at the same time, all delivered at levels both Joe Sixpack and the POTUS can easily understand. Much to the delight of eager attendees of previous speaking engagements, Schuessler, through his strange and foreign magical powers has proven over and over again the Ebbinghaus effect does not apply when he’s in the room.

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More Lloyds of London History By Miller

Charlie Chaplin’s original costume was insured at Lloyd’s of London in the mid-1920.

By Paul Miller

The cutaway coat, baggy trousers, over-large boots, felt hat and cane were covered whilst being transported to an exhibition in New York. Whilst they were said to be “worth two shillings to an old-clothes dealer”, they were insured for £10,000. Under the terms of the policy, the clothes had to be guarded at all times and kept in a vault when not being worn.

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Reinsurer Pulls Out Leaving Texas School District Risk Manager Speechless

“I don’t find myself speechless very often” ` – Chris Bomberger,

” The Texas School Health Benefits program sent out the distress signal to districts that had pulled out of the state’s benefits system for educators: their reinsurer had pulled out of covering 51 Texas school districts who had negotiated their own benefits to find better cover coverage, better prices or both.”

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Marpai Announces Something But We’re Not Sure What It Is

Marpai Announces “Off-Cycle” New Client Agreement

Source: Marpai (Nasdaq: MRAI), 3/5/2024

Tampa — Marpai, Inc., an independent national Third-Party Administration company transforming the $22 billion TPA market supporting self-funded employer health plans with affordable, intelligent, healthcare, announced that it has signed a three-year agreement to provide healthcare benefit services to a regional organization based in the southeast.

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Fear-Based Propaganda Profits Big Pharma

“It used to be that pharmaceutical companies were working with the doctors. Now, unfortunately, pharmaceutical companies are captured by the price of their stock. Venture capitalists own the pharmaceutical companies, they own the clinical research organizations, they own the site, and they own the institutional review board. They own the advertising and the marketing. They influence through the media. And so, unfortunately – it’s a loaded question – but it’s a big market. And what we saw during this pandemic was the price of the stock mattered more than the price of a life.”

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Don’t Ask, Don’t Tell

How To Find Out How Much Your Broker Is Getting Paid

Under new federal transparency laws health insurance brokers must disclose commissions /compensation to clients and prospects. Most have chosen to ignore the law and continue to do business as usual. Jeffrey Hogan offers tips for employers who are curious how much they are paying their broker but don’t know how to ask.

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What Do These San Antonio Medical Providers Have In Common?

The following information is not subject to any gag clauses, NDA’s or Non-compete agreements common to traditional managed care contracts. Students passing this test earn an honorary Doctorate from RiskManagers.us and will forever be addressed in the most appropriate manner, commanding respect and adoration within the close-knit world of fee-for-service health insurance consultants from sea to shining sea.

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Quote Of The Day

“I can make the case that almost no healthcare vendors care about anything other than setting themselves up to be acquired by the PE industry. Once purchased, all the PE firms care about is expanding profits quickly to allow for a quick flip. This includes RBR firms, TPAs, brokers, and PBMs. No one is advocating for the employer and when the efficient market concept kicks in, everyone will be sorry. Employers will eventually get their revenge on all the players who abuse their relationships many of which have fiduciary responsibility.” – Mike Dendy

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An Antidote For Frankenstein Health Plans?

“We have a Frankenstein Health Plan! PLEASE tell us about your Sleeping Beauty Health Plan!” – Struggling in Pretoria

A recent post on Linkedin rings true:

“It’s a bit crazy that many brokers are so terrified of Medical Cost Sharing + DPC that they will put together the ugliest Frankenstein of a health plan with 12 different vendors and like 20 contracts for an employer who has no clue how it all works. The employees are utterly confused and need to be handheld by some random RN who serves as care coordination. Still almost no consumerism injected into the plan. Just a ton of steerage, coordination, and handholding. Is that really “innovative”?  Yeah, I guess you saved the employer money for a few more years, but it still seems pretty unsustainable.” – Ben Butler

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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.

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Blue 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.

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Non-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.

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An 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.

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MexRx

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.

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South 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.

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