Archive for the ‘Uncategorized’ Category

Blue Cross of Texas vs Blue Cross of Alabama

Friday, April 16th, 2021

Blue Cross of Texas can’t be very happy about this nor can their largest Texas client.

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How To Make Medication More Affordable

Friday, April 16th, 2021

I wanted to follow up from my previous email and share our resource that provides insight on how to make medication and treatment for acute and chronic conditions more affordable.

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Silver Plan For $10 Per Month? Sign Me Up Scotty!

Friday, April 16th, 2021

If you are paying more than $10 for a Silver equivalent health insurance plan through your employer, you may qualify for a better deal in the individual health insurance marketplace.

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TRS ActiveCare’s Hostage Taking Strategy Under Siege

Friday, April 16th, 2021

“Next year these districts will have access to their own claim data with which they can directly competitively bid out their TRS ActiveCare alternative plans. That will be a game changer.”

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90 Degrees Benefits Rocks TRS ActiveCare Officials

Thursday, April 15th, 2021

90 Degrees Benefits Blitzkrieg

By Bill Rusteberg

For the first time in almost 20 years the TRS ActiveCare government health plan for Texas school districts must compete for business. Previously this government funded public health plan held a monopoly on Texas school business, protected by statute from commercial competition.

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Newly Designed Scale For Physician Practices

Wednesday, April 14th, 2021

It’s All About The Money

Wednesday, April 14th, 2021

Two legislative sessions ago (Texas legislature meets once every two years) I was involved with a group whose goal was to influence certain legislative initiatives towards reforming public health care financing in Texas. We met with all the right people as well as highly connected lawyers active in the political arena. It quickly became evident we were not going to be successful without hiring them directly or their surrogates on a monthly retainer fee basis.

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No Ding Credit Bill Does Not Apply To Texas RBP Plans

Tuesday, April 13th, 2021

Reference Based Pricing Vendor Reacts

Texas Attorney General Opinion issued April 13, 2021 negatively affects Reference Based Pricing plans in Texas.

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Are You Getting Proper Underwriting Credit?

Tuesday, April 13th, 2021

Are you getting proper underwriting credit for your Reference Based Pricing plan?

“When it comes to stop loss options, most carriers are pooling the highly engaged employer with a large block of business made up of groups who have not adopted the best programs to contain costs and improve the lives of their members.”

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TPA’s & The Maytag Repairman

Tuesday, April 13th, 2021

Cash-pay centric health plans are turning TPA’s into Maytag repairmen lookalikes. In this case the phone has stopped ringing by 90%………………

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Historic Breach – The Political Value of PHI

Friday, April 9th, 2021

The first documented PHI breach by government officials…….Government operatives steal PHI from locked filing cabinet for political purposes……

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The Poorer You Are The Richer You Become

Friday, April 9th, 2021

Check out the Redistribution of Wealth Calculator to find out if you qualify…………….

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Rx Patient Assistance Programs

Friday, April 9th, 2021

“What did you just say! Free Drugs? Where?

If you’re single earning less than $75,000 you will qualify for free specialty drugs through Big Pharma. Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine.

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Meet The Billionaire Who Controls Your Medical Records

Friday, April 9th, 2021

Epic Systems founder Judy Faulkner built an empire pioneering—and later dominating—electronic medical records. For decades, she’s kept them walled off from competitors, but now the pandemic is fueling a digital health care race that might finally topple her from the throne.

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Meet The New Chinese Flu Billionaires

Friday, April 9th, 2021

Chinese manufactured flu virus spawns instant Chinese billionaires and others across the globe. Manufacturing a problem then selling a solution is very smart business.

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Schuessler & Company – The E.F. Hutton of Health Care

Thursday, April 8th, 2021

“We eliminate the middlemen,” says Schuessler, inventor of The Schuessler Stick™.

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Bankrate Publishes Guide For Financial Rx Assistance

Wednesday, April 7th, 2021

I thought your readers would benefit from our guide on financial assistance for prescription medication……………..

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Damian Lamendola Sells Continental Benefits

Saturday, April 3rd, 2021

Founded in 2013, Continental Benefits operates in all 50 states.  It is a privately owned organization headquartered in Tampa, FL.

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Want Your Claims Experience? It’ll Cost $2,000

Saturday, April 3rd, 2021

TRS officials say if HB 1342 passes the Texas legislature this session it will cost $2,000 per school district to provide their own claim experience……………..

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It’s Money For Nothing When The Risk Is Free

Saturday, April 3rd, 2021

I’ve often argued that health insurance companies in the U.S. provide almost no real insurance because they assume almost no actual risk from the people they cover. I think their financial disclosures from last year back up what I’ve been saying.

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American Greed Grips Big Pharma

Saturday, April 3rd, 2021

Just because you can charge $2.1 million doesn’t mean you should charge that amount.

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RiskManagers.us Receives Nobel Peace Prize

Thursday, April 1st, 2021

Texas based insurance group receives word via Linkedin. Waiting for confirmation call from Oslo.

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You Gotta Pay Up Regardless of The Final Diagnosis

Wednesday, March 31st, 2021

Relating to the definition of emergency care for purposes of certain health benefit plans…..

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You Can’t Squeeze Blood From A Turnip

Tuesday, March 30th, 2021

Pharma Witch Brews New Specialty Drug

Excluding or Carving-Out Specialty Drugs – When specialty medication is excluded from the covered benefit, the member is completely on their own to cover the expenses for their specialty medications”.

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Spurious Single-Employer Self-insured Group Health Plans Hurting Vulnerable Consumers

Sunday, March 28th, 2021

 A report, issued by a mysterious group of 30 unnamed patient organizations warns consumers to avoid these plans – and a call to action to lawmakers to step in and end them………….

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Man With Upside Down Head Fears Chinese Virus

Saturday, March 27th, 2021

A BRAZILIAN man with an upside-down head has revealed his terror of catching the Chinese Virus.

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The Lisa Plan

Saturday, March 27th, 2021

Happy Hour Outline of The Lisa Plan

The Lisa Plan is the future of healthcare financing. It makes sense for all the right reasons. Providers win, patients win, and employers who fund all of this win too.

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The Future is Here!

Friday, March 26th, 2021

Cash pay centric health plans, coupled with PCP medical  homes is the future of employer sponsored healthcare. And the future is NOW!

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Friday, March 26th, 2021

Texas Legislature Considers Two Bills of Interest

Wednesday, March 24th, 2021

Senate Bill 1684l is action packed with many items of interest particularly to Reference Based Pricing plans and includes, among other things, this:

Hospitals must list the gross charges for each health care service provided by the facility with the Medicare reimbursement amount for the health care service next to the relevant gross charges.

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Government Turbocharges Individual Health Insurance

Wednesday, March 24th, 2021

Government subsidized individual health insurance creates an unfair advantage for private employer sponsored health plans……………

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Oh Oh, No More Secret PPO & PBM Contracts

Tuesday, March 23rd, 2021

Managed Care Rep. Reacts

Most group plans will be required to provide members (1) In-network provider rates for all covered items and services (2) Out-of-network allowed amounts and billed charges for all items and services and (3) Negotiated rates and historical net prices for covered prescription drugs.

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Chinese Virus Impacts Cheerleader Squad

Tuesday, March 23rd, 2021

Holy cow: 42% of Americans report undesired weight gain during Covid 19. The average weight gain is 29 lbs. And 41 lbs for Millennials! This will ramify for years to come.

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Oral Vaccine For The Dreaded Chinese Virus

Tuesday, March 23rd, 2021

SOURCE: The Jerusalem Post
An Israeli-American pharmaceutical company is preparing to launch a Phase I clinical trial for what could become the world’s first oral COVID-19 vaccine.

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Reference Based Pricing Fees

Tuesday, March 23rd, 2021

Guess how many TPAs or consultants are willing to implement reference-based pricing on a flat fee structure? Very few, if any.” – Mark Flores

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Reference Based Pricing Under Fire

Monday, March 22nd, 2021

A recent Supreme Court case in Texas involving a hospital lien held that contract payments involving Medicare multipliers and other accepted payments could be evidence of reasonable, fair market value.

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Plan Sponsors Slapped Senseless

Sunday, March 21st, 2021

Plan Sponsor takes another hit from Prescription Queen

“The fact that a drug is 10% higher in cost or in price than last year, it doesn’t mean it’s 10% more effective. It just means that because payers are willing to pay for them, that [the drug makers] keep increasing the price”

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Wanted: PBM To Administer An Essential Medicines Rx Plan

Friday, March 19th, 2021

The World Health Organization (WHO) has developed a list of essential medicines that “satisfy the priority health care needs of the population.”

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Is Replacing Your PBM With GoodRx A Good Idea?

Friday, March 19th, 2021

GoodRx co-founder Doug Hirsh once said: “A company like ours should not have to exist.”

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Who Gets The Clawback Money?

Thursday, March 18th, 2021

By Molley Mulebriar

“This nightmare scenario is something that’s been happening to more and more pharmacies over the past few years. It’s part of a widely reviled practice called “clawbacks” — fees, often totally unpredictable, that PBMs charge pharmacies to “claw back” some of the money they’ve already paid them in reimbursements.”

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How To Use GoodRx To Check Drug Prices

Tuesday, March 16th, 2021

When a Doctor Prescribes You a Medication, Look It Up on the GoodRx App While Still in the Examining Room.

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Tuesday, March 16th, 2021

San Antonio Ordinance Violates the Texas Minimum Wage Act.

Sunday, March 14th, 2021

San Antonio’s sick & safe leave benefits ordinance would have required private employers to provide certain paid sick and safe leave benefits to employees based on hours worked within the city limits.

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Having Skin In The Game Almost Never Works In Health Care

Sunday, March 14th, 2021

“Skin In The Game” in health care spending really means the misguided hope of wise consumer spending using thousands of dollars they don’t have. But on the other hand having no “Skin In The Game” ends with the same results. In the later case Fat Albert would be wearing some outstanding duds courtesy of other people’s money.

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Shark Advocacy Rx Program

Sunday, March 14th, 2021

Taking a high cost maintenance, brand or specialty medication?

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Drug Fueled Rage Gripping Plan Sponsors

Saturday, March 13th, 2021

Price of Drugs Is Too Damn High!

By Bill Rusteberg

High cost specialty drugs can bankrupt a self-funded plan, even if you have stop loss cover. It’s just a matter of time. So do you act now to preserve your plan or do you wait until it’s too late?

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100 Percent COBRA Subsidy Starts April 1

Friday, March 12th, 2021

“Plan administrators should identify the individuals who will need to receive a notice about the new subsidy…. Generally, this means anyone who had — or could have had — COBRA as far back as November 2019, because their 18 months of coverage would extend through April 2021.”

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Another Texas School District To Join The Rebellion?

Friday, March 12th, 2021

“There has been a lack of transparency in the bidding process that has caused some of us concern about how rates with such a large pool of people continue to climb at exorbitant levels………… And the sheer fact that I believe with local control we can actually reduce some of those rates and maintain, if not improve upon, the benefits, it’s something we need to look at.”

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Carl’s Employer Built Health Care

Friday, March 12th, 2021

Employer built health care vs carrier built health care……………….

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Medical Community & Cash Pay Centric Health Plans – An Eternal Love Affair

Thursday, March 11th, 2021

Most Americans are insured through their employer’s health plan. The problem is most employers don’t treat healthcare like they do every other purchase. Those few that do reduce their costs by as much as 50% while improving benefits at the same time.

They know the cost of health care has remained essentially static for the past 15 years or more while the cost of health insurance hasn’t. They know because they took the time and effort to educate themselves as to the true cost drivers of health care enabling them to take corrective action.

They took the time and effort because they are the only employers that truly care about their employees (and their bottom line).

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Preauthorization Bills Introduced in Texas Legislature

Wednesday, March 10th, 2021

HB 410 is the first TMA-supported prior authorization bill this session to get a hearing, but it’s just one piece of TMA’s broad offensive on the practice.

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A Texas School District Finds Comprehensive Benefits Package

Monday, March 8th, 2021

A Texas School District Finds Comprehensive Benefits Packages

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What Does The Chinese Flu Have To Do With ObamaCare Subsidies?

Monday, March 8th, 2021

Insurance companies will benefit most by receiving even larger government subsidies on behalf of people who already have coverage,

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The Payer You Never Heard Of

Sunday, March 7th, 2021

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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Actuarial Calculations The Old Fashion Way

Sunday, March 7th, 2021

Unless you’re intellectually bleached, actuary work in forecasting medical trends and rating basis is not rocket science. Manipulation of value parameters is made easier with a Dial A Matic.

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TRS ActiveCare Trustees Concerned About Competing Coverage Options

Saturday, March 6th, 2021

Over 140 Texas school districts now offer a TRS ActiveCare commercial health plan alternative, effectively challenging the TRS ActiveCare mandate prohibiting member districts from doing so.

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Following The Flow of Drug Kickbacks (Rebates)

Saturday, March 6th, 2021

Drug kickbacks / commissions (rebates) can account for about 20 – 30% of an employer’s drug spend…….

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Solving Health Care Is Not Rocket Science

Saturday, March 6th, 2021

As consumers, we do have the power to say that hospitals and some doctors have been riding the gravy train on the backs of American employers for far too long, and it is time to derail it.

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Amazing What You Can Do In 10 Minutes in Deep South Texas

Friday, March 5th, 2021

Courtesy Timer For New Yorkers (Not For Use In South Texas – It doesn’t Snow There)

The following is a true story:

By Molly Mulebriar

I dialed the number and almost immediately the mark answered with “I’ll call you back in ten minutes!”

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David Rendall Is Recognized with CEO Today‘s Prestigious Global Award

Friday, March 5th, 2021

We are pleased and honored to announce David Rendall has been selected as the recipient of the prestigious 2021 CEO Today Global Award for North America. The influential CEO Today magazine recognizes and honors the most respected international business leaders and singles out those who consistently disrupt the industry’s status quo to lead their company to new levels of innovation and growth.

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Small Group Health Sales – It’s Worth Your Time

Friday, March 5th, 2021

Liz Wilson

You can earn $6,000 on average when you sell a Funding Advantage level funded plan for a 15-person group – more if you add dental and vision. If you need more compensation, just tell us the amount you need and we’ll build it in.

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School District Becomes The First State Approved Vaccine Provider

Thursday, March 4th, 2021

Stetson Roane is an exceptional leader who doesn’t understand the concept of “It Can’t Be Done.”

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Texas Declares Independence……..Again

Tuesday, March 2nd, 2021

What did the governor just announce Tonto?

Tonto convinces Texas governor to reaffirm Texas independence…….Will other states follow?

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Health Plan Claim Analytics – Self-Insured Reporting

Tuesday, March 2nd, 2021

Four years later and a (cough) amount of money, here we are . . . and the results are better than anyone could have imagined………………

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Victor’s Feats Were Never As Good As This One

Monday, March 1st, 2021

Victor Lustig was a world class hustler in his time but he never had an opportunity like this one……….

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What If Commercial Health Plans Paid 100% of Medicare……………..

Monday, March 1st, 2021

Hospital Administrator Reacts To Study

Study shows total health care spending for the privately insured population would reduce 41% if employers and other insurers reimbursed health care providers at Medicare rates. 

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Cash Driven Health Plans Make Sense

Sunday, February 28th, 2021

Great Ideas And Business Models Are Often Memorialized on Bar Napkins…………………

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Unmasked: Someone Is Lying

Sunday, February 28th, 2021

“We will need to continue to wear masks into 2022!” says a Biden administration official. “We’ll be done with the scourge by April 2021!” says a medical expert. Someone is lying and I suspect we know who it is…………..

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Fee-for-Service For Primary Care is Dumb………..

Wednesday, February 24th, 2021

Fee-for-Service Primary Care Only Pays $60 – $140 Per Visit. However, Primary Care Has Been Shown to Decrease Hospitalizations by 20%… Saving $50,000 Per Hospitalization.

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Elephant Lives Matter

Sunday, February 21st, 2021

Texas House Bill 1941 was introduced this month because some believe Elephant Lives Matter…………

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The First PPO Was Established in 1982 – And It’s Still Touting Savings?

Sunday, February 21st, 2021

If PPO’s are supposed to save us money on health care why hasn’t it? We all agree forty years of managed care hasn’t worked so why are we still hoping it will?

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The (never ending) La Joya Shit Show Continues…………….

Friday, February 19th, 2021

You can’t make this stuff up………………………..

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To Our Friends Up North, Please Come Get Your Weather!

Wednesday, February 17th, 2021

Thank you for your (pick one) EMAIL. VOICEMAIL……….…………

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Overcoming Misconceptions About Health Benefits

Monday, February 15th, 2021

“If you went to Denver, Dallas, OKC or ABQ you would not find a better benefits consultant. Very helpful and knowledgeable. Out of the box thinking.” – Alan, Ideacom

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Another Healthcare Benefit Alternative To TRS ActiveCare

Sunday, February 14th, 2021

There is yet another vendor offering Texas educators a TRS ActiveCare alternative strategy which is (drum roll please)…………………….

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