Uncategorized – Risk Managers

Insurance Broker Earns $2 Per Prescription

An insurance broker for a 10,000 member Texas public school district is said to be earning $2 per prescription in undisclosed commissions.

The Smoke & Mirrors of Carrier Credits

“Add a margin then gift it back when necessary………………Age old marketing trick we used in the 70’s and early 80’s when working for a national health insurance company. We always had 5% in our back pocket. Some things never change.” – Bill Rusteberg

The Hardest Job In The World

Health insurance customer service representatives have the hardest job in the world. They are constantly abused on a daily basis by unhappy, emotional and deaf customers immune to reason and logic. No one ever thanks them.

To Fix Healthcare, We Need To Change The Rules

“Rules allow an employer to move a bad risk in the middle of a large claim to another insurance company on the individual health insurance marketplace. “

Here’s What I Learned About Insurance

My house burned: here’s what I learned about insurance……………

Another Truth Bomb By Rojas

By Dutch Rojas

A self-funded health plan for more than 150 employees has less risk than a fully insured plan.

Brick & Mortar Direct Primary Care vs Virtual DPC

I’ve interviewed a number of direct primary care (DPC) organizations and asked each what their virtual engagement rate was vs brick & mortar appointments. Virtual visits run from 60 to 90%. of total visits.

Federal Trade Commission Report On Specialty Generic Drugs Will Curl Your Toenails

“A Growing Profit Center for Vertically Integrated Pharmacy Benefit Managers”

“The Big 3 PBMs’ affiliated pharmacies generated significant and growing levels of revenue in excess of estimated acquisition cost (NADAC) on the most highly marked up specialty generic drugs…………… the Big 3 PBMs also appeared to take in significant income from spread pricing………….plan sponsors in particular should be aware that they and their members are paying the Big 3 PBMs and their affiliated pharmacies very significant markups over the acquisition costs for critical medications.”

Will Someone Please Help Texas School Teachers?

The Texas legislature is now in session to consider hundreds of bills filed for various wish lists driven by vested interests.

The Difference That Makes A Difference

Abrogating the often repeated “We take care of our employees” brain dead BUCA heath plan sponsors reduce claim costs by paying less while plan members pay more.

Heuro Health’s Obesity & Diabetes Management Program Can Make A Difference

By Jeff Bernhard, President Heuro Health

Yesterday, I had the privilege of speaking with one of our patients who is currently on our weight management and lifestyle program and Journey. This individual also has pre-diabetes and has spent years trying to improve her health by losing weight. She shared her satisfaction with Heuro Health, praising the structured nature of our program and how easy it was to access the care she needed. Our dietitians, coaches, and obesity-trained doctors all worked seamlessly together to support her while she is on weight loss medication.

The Truth About Big Pharma – Why Americans Pay The Price

High cost drugs are bankrupting heath plans. Everywhere we go we are invariably asked “What can we do to lower our prescription drug costs?”

Mel Gibson Tells Joe Rogan Ivermectin ‘Cured’ Stage Four Cancer

GIBSON: “I have three friends. All three of them had stage four cancer. All three of them don’t have cancer right now at all.”

ROGAN: “What did they take?”

Orforgliprum To The Rescue!

Promising new experimental weight loss drug to be approved as soon as next year.

Judge Frank Caprio

Frank Caprio

Government Ratches Up Punishment For Wayward Plan Sponsors

It’s no wonder employers are ditching their health plans in favor of ICHRAs! They want out of the health insurance business and news like this adds urgency to their angst…………

Zepbound Outperforms Wegovy: What Employers Should Know

SOURCE: Lockton

The first clinical trial directly comparing weight-loss drugs Zepbound and Wegovy has confirmed previous placebo-controlled trial results indicating that adults taking Zepbound experience greater weight loss.

The Cost Of Obesity & Type 2 Diabetes Is About To Explode

More plan members are taking expensive obesity and diabetes related drugs like Ozempic and Monjaro raising prescription drug spend for plan sponsors to unsustainable levels.

The Only Thing A Son-Of-A-Bitch Understands is Another Son-Of-A Bitch

A hospital refused to accept a patient’s Reference-Based Pricing health plan and demanded cash instead. Their demand was 1,500% of Medicare minus a 5% discount.

Frontier Airlines Is Expense Account Friendly

Frontier Airlines will begin operating a new nonstop route between the Dallas Fort Worth International Airport and JFK International Airport in New York City in late April.

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

The Biden Administration provided in a recent press release that the CFPB or the aptly titled “Consumer Financial Protection Bureau” is finalizing a rule to remove all medical debt from consumer credit reports AND to prohibit unpaid medical bills from preventing access to credit. The devil is always in the details:

Nueces County Health Plan 1984

What do James Presley, Bob Barnes and William Rusteberg have in common? The year was 1984, Corpus Christi, Texas.

Jennifer Henry

Boon-Chapman is proud to spotlight Jennifer Henry, our Vice President of Sales! With over two decades of experience in the employee benefits industry, Jennifer brings a wealth of expertise and a passion for building sustainable benefit plans.

CFPB Finalizes Rule to Remove Medical Bills from Credit Reports

Final rule will remove billions of dollars of medical bills from credit reports and end coercive debt collection practices that weaponize the credit reporting system

Global Excel Acquires Vitori Health

For immediate release:

January 7, 2025

Global Excel Management Inc. Acquires Vitori Health LLC.

SHERBROOKE, Jan. 7, 2025 /PRNewswire/ — Global Excel Management Inc. (Global Excel) is pleased to announce it has acquired the business of Vitori Health LLC (Vitori Health) effective January 1, 2025.

How Much Does Ozempic Cost in the UK?

While having coffee in Houston this morning the vendor I was visiting with said “Bill, we can get Ozempic for $300 through our sources in the UK. And we can get Monjaro for $400. Both prices incude shipping!”

Dr. Fu

“Titi Nab Fu would have been partly responsible for the area’s universally accessible healthcare system that included non-invasive surgeries, bone setting, dentistry, and an extensive range of pharmacological treatments,“

How Insurer of Last Resort Facing $5.8 Billion Exposure Leverages Capacity

“How are we going to pay these claims? We’ve run out of money!!” says the claims department. “No problem” says management, “We have a Plan B, and if that doesn’t work we have a Plan C, and, God Forbid, if that doesn’t work we have a Plan D!”

Proposed Name Change For Gulf of Mexico

We like Gulf of Texas better buy hey, we’ll go along with Gulf of Buc-ees.

Dr. Bill’s Urgent Care Visit

By Bill Hennessey, M.D. – View my services

Sanford Health Bills Incorrectly and Excessively for an Urgent Care Visit

One hour and 4 departments later in a Sanford debacle, after encountering multiple lies, I was told that for a NEW urgent care visit the billing code would most commonly be 99124, which is a CPT code for a FOLLOW UP visit, even as per what they just USPS mailed me. Note further I was verbally told that $346 was “the starting price and depending on what was done it could go up to $800.”

Marpai Raises $5,000,000

“The proceeds from the sale will be used to fund several of our ongoing growth initiatives and support a strong working capital footprint,” said Damien Lamendola, Chief Executive Officer of Marpai.

South Texas Research Scientist Advocates For Ozone Therapy In Battling Chronic Illnesses

“This will set off a major battle,” Rainey said. “The nephrology industry and big pharma won’t like this. It’s a billion-dollar dialysis and transplant business.”

Frontier Direct Care Announces Initial Closing of its $20 Million Series B Financing

HARLINGEN, Texas, Jan. 8, 2025 /PRNewswire

Frontier Direct Care, a leading innovator in employer-funded healthcare, has announced the initial closing of its $20 million Series B funding round, led by Mehshah Capital. This investment will accelerate the company’s mission to transform healthcare by delivering accessible, affordable, and high-quality care to employees and their families.

FC&S Expert Coverage Interpretation

Get current and immediate answers to specific claim and policy questions with FC&S Expert Coverage Interpretation — a unique, online resource designed for those who have a demand for highly complex and hard to find, quality information for specific claim needs and questions.

Important Notice for Members with Serious Medical Conditions

“It’s never been our intent to hire a walking, breathing million-dollar claim liability” purrs the nice HR lady during orientation. “We operate under a “No Ask, No Tell” doctrine in order to avoid discrimination lawsuits, But………..we have a really sneaky solution and your job depends on it!”

The Mahoney Group “Pulls The Trigger in 2023”

“This solution removes all traditional insurance companies from your plan. The consulting/brokerage industry is deeply infested with private equity and Wall Street.”

Hospitals Lose Their Hammer

Reference Based Pricing plans are rejoicing over the news. Plan members will no longer have to worry about having their credit ruined by arbitrary turbocharged hospital chargemaster rates and the threats that follow when plan sponsors move away from managed care contracts.

Canary’s Emergency Grants Help Employees Stay Financially Afloat

“Removing that HR layer, where someone doesn’t have to report to their boss or let their colleagues know what’s happening, lowers the barrier for people who really need money to come and get it because they remain anonymous.”

Texas Medical Board Battle: Who Is Dr. Robert Bredt?

“Dr. Robert Bredt was a relatively obscure figure until the Texas Medical Board announced that it sought to use him as an expert witness in its case against COVID crusader and Houston ENT Dr. Mary Talley Bowden. The case concerns whether Bowden had the right to attempt to treat Jason Jones with ivermectin while the COVID-19-infected deputy sheriff was hospitalized at Huguely Hospital in Fort Worth.”

Texas Hospital Districts

HEALTH AND SAFETY CODE
TITLE 4. HEALTH FACILITIES
SUBTITLE D. HOSPITAL DISTRICTS
CHAPTER 286. HOSPITAL DISTRICTS CREATED BY VOTER APPROVAL

“Any facility that is organized consistent with this statute must first determine ability to pay first and then dependent on the conclusion is only entitled to collect the cost of providing the care. Patients are also entitled to a hearing in the local courthouse if no mutual arrangement can be made.”

Pet-USA

75% of claims paid within 24 hours, 95% within one week. Rated best pet insurance on the market.

Big Pharma Knows How to Prevent Cancer, But Chemotherapy Makes Them Billions

Fascinating interview – Chemo, Ozempic…………………..

San Patricio County Awards Insurance Consulting Agreement

San Patricio County has concluded a Request for Qualifications (RFQ) process in search of a fee-based insurance consultant, The RFQ was released in September 2024.

Family Business Had No Insurance On $600,000 Asset

“The jewelry store, a family-owned operation, was built with years of hard work and sacrifice. Cuenca’s mother started the business with a $3,000 loan, working tirelessly, often putting in 80 hours a week. Tragically, the jewelry stolen was uninsured, leaving the family with a huge financial void….”

Waisted Money, Waisted Days

More and more plan sponsors are singing Freddy Fender’s Wasted Days, Wasted Nights these days. “We spend hundreds of thousands of dollars on medication that didn’t need to be!” can be heard in board rooms across the Fruited Plains.

This Seven Word Sentence Will Lower Your Hospital Reimbursement Rates By 5-10%

Try this when negotiating a direct hospital contract and see the reaction from across the table: “We will remove all prior-authorization requirements.”

GLP-1 Withdrawal Can Have Lasting Health Effects

“While many patients can shed up to 20% of their body weight using the injectables, the cost of the drugs and side effects like nausea and vomiting lead many to qui within one year of withdrawal, the participants in a 2022 study]regained two-thirds of their prior weight loss, with corresponding changes in risks for conditions like heart disease and Type 2 diabetes.”

Zepbound Could Become Biggest Single Cost Driver For Employer Sponsored Health Plans

Lilly’s Obesity Drug Zepbound To Be Key 2025 Health Cost Driver

Bruce Japsen – Senior Contributor – Bruce Japsen writes about healthcare business and policy.

Jan 1, 2025

The anti-obesity drug Zepbound made by Eli Lilly & Co. could be one of the biggest cost drivers for health insurers, employers and government health programs that cover it this year.

It Takes A Rebel To Start A Revolution

In a 2007 meeting with a large Texas employer I recommended they walk away from PPO networks and pay claims based on certain pre-defined metrics. Immediately the TPA account manager chimed in “It won’t work! Hospital and doctors will not take the insurance, members will be denied care. Don’t do it!” she said.

We did it anyway. And it worked. And it started a revolution…………

Risk Management Strategy For Type 2 Diabetes

“We will cover GLP-1 for type 2 diabetes as long as you participate in the therapeutic journey to help you achieve remission and be healthy.” – Quote Stolen From Jeff B.

The New Retirement: Baby Boomers Who Are Not Slowing Down

SOURCE: Dallas Expresss

In a shift from traditional retirement, a growing number of baby boomers are choosing to work well into their sixties and seventies.

How Much Would The Texas State Employee Health Plan Save At 200% of Medicare?

Visualizing the Impact of the Hospital Payment Caps

The Hospital Payment Cap Simulator provides anyone from policymakers to researchers with insights into how much state employee plans across the US could save from hospital payment caps and the impact on commercial hospital operating margins. Read the instructions below to learn how to use the tool.

What Is Elon Up To Towards Solving Health Care For His Starbase Employees?

By Bill Rusteberg

Elon Musk has transformed Boca Chich beach into a mega space exploration center by investing over $3 billion mere yards from the Gulf of Mexico. Last we heard there are more than 3,000 employees working there.

They Were Entitled to Free Care – Hospitals Hounded Them to Pay

More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.

Another South Texas School District Robs Employees of Better Benefits

Another Lower Rio Grande Valley school district gifts employees $4.8 million Christmas Bonus robbing plan members of better health insurance. The McAllen Independent School District gifted millions too as a “retention” bonus.

Type 2 Diabetes Remission Program For The Lower Rio Grande Valley

“The Rio Grande Valley has one of the highest rates of diabetes in the entire country. The rate is 18% above the national average, according to recent data from the University of Texas Health School of Public Health in Brownsville. Oftentimes, a lot of people don’t even know they have diabetes.”

Health Insurance Commissions vs RiskManagers.us Fees

Since transitioning from commissions to fee based consulting in 1997 I’ve often found plan sponsors reluctant to accept our fee schedule. “That’s too much! We don’t pay our broker anything, the carrier pays his fee!”

What Is An Actuary?

“An actuary is a person who passes as an expert on the basis of a prolific ability to produce an infinite variety of incomprehensible figures calculated with micro-metric precision from the vaguest of assumptions based on debatable evidence drawn from inconclusive data derived by persons of questionable reliability for the sole purpose of confusing an already hopelessly befuddled group of persons who never read the statistics anyway.” – Daren Daley, Perr & Knight

80% Want Higher Health Insurance Rates

“Among U.S. adults, 80% say insurers should cover weight loss drugs for adults diagnosed as overweight or obese.”

Elon Musk’s ‘Ozempic Santa’ Post Turns Heads

Alyssa Goldberg – USA TODAY

On Christmas Day, Elon Musk turned heads with a decadent photo by his tree. Dressed head-to-toe in a Santa costume, he captioned his photo “Ozempic Santa,” flaunting a slimmer figure.

QUOTE OF THE DAY

“If your broker had you auto renew with either BCBS or UHC, you paid them $20-$50 a month per employee to buy what you need zero advice for. You don’t need to pay someone to buy McNuggets.” – BJ Spyksma, CEO Apios

Are School District Cafeteria Plans Accepting Illegal Inducements?

Texas public school districts routinely employ third party administrators at no charge to act as a single source premium remitter with convenient online enrollment capabilities in return for the privilege of selling commission generating insurance products.

This Independent Assessment Can Save Employers Billions On Healthcare

“81% of employers unknowingly expect a fox to guard their hen house, and this is why some leading ERISA attorneys consider the use of brokers for consulting and procurement illegal.”

Fixed Indemnity Insurance Consumer Notice Abolished By Federal Court

Federal court rules consumers are not so dumb they don’t understand what they are buying.

Bay Bridge Administrators

Bay Bridge Administrators is a full-service, nationally recognized, third party administrator of fully-insured employee benefit plans. We are licensed and bonded and we represent only top-rated insurance companies.

UnitedHealthcare & The ObamaCareCon

By Allysia Finely

“We’ve gotten to a point where healthcare is so inaccessible and unaffordable, people are justified in their frustrations,” CBS News medical contributor Céline Gounder said during a Friday segment on the roasting of health insurers…

The Story of ‘Santa’s Last Journey’

Article Referred By Jody Bright

“Rumors are flying around Washington to the effect that this may be Santa Claus’ last year of operation. Sources within the Federal bureaucracy are privately indicating that the jolly old man is in big, big trouble!”

RiskManagers.us 2025 Fee Schedule

“RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.“

The following is the RiskManagers.us 2025 Standard Fee Schedule and Consulting Agreement for new business: