The Cash Pay Revolution Continues

“Cash has more power and influence than a health insurance card with a logo” Molly Mulebriar

The Curative Zero Card has a new name: the Curative Cash Card. Why? Because it now covers even more services, and makes it even easier for members to use their $0 benefits.

Rx Flyer Found In Lonely Rural Mailbox

In a remote part of a South Central Texas county there stands a lonely mailbox, the last one on a rural route 12 miles from a city no one has ever heard of. It’s a window to a wider world of strange and amazing things……………

Carrier Ditches Traditional Group Insurance Plans To Promote ICHRA

Insurance company announces it will exit the fully-insured, self-funded and level funded market to concentrate on individual policies through Individual Coverage Health Reimbursement Arrangements (ICHRA).

“We are committed to helping employers find affordable health insurance options for their employees. We believe that one answer can be found in our individual plans and are excited to provide a solution for employers in CT through an Individual Coverage Health Reimbursement Arrangement (ICHRA).”

Mark Cuban Floats Bold Healthcare Plan: ‘Zero Premiums To Insurance Companies’ With A Cash-Pay Revolution

“This is not a new idea but a good old idea. Cuban proposes the government provide the equivalent of a $50,000 stop loss policy for all Americans – an ACA Re upgrade. Let’s do it!” – Molly Mulebriar

Federal Judge Rules Providers Can Sue To Enforce Unpaid IDR Awards

“Get your check book ready………………” – Don Pedro

Eliott Listman – Allia Group – Litigation CEO

A federal court in Connecticut ruled that providers can sue to enforce unpaid IDR awards under the No Surprises Act, rejecting insurer arguments that there’s no private right of action.

Even The Clouds Know

Picture stolen from Josua R …….

Do we still need traditional PBMs?

“It’s evidently possible to run an effective discount network without the associated bloat and misaligned incentives of a traditional PBM…..”

Bird Dogging Jilted Lovers

ICHRA administrators don’t need brokers but they pretend they do. They often play both sides, direct sales and broker introduced door opener sales.

Nobody Hates Insurers Like Doctors

By Craig Gottwals

“While hospitals and insurers are milking employers for two to six times Medicare every chance they get, doctors get the stuffing kicked from them in the insured market. “

Medicare and Social Security Go-Broke Dates Pushed Up Due To Rising Health Care Costs

Medicare is on track to be broke in eight years. If Medicare For All is implemented then it stands to reason the Medicare risk pool will benefit by the addition of younger and healthier people. Odds makers expect that to happen because it will. Medicare won’t be a risk pool of oldies anymore.

Nothing Is Forever

Government “enhanced” premium assistance for ACA plans is set to expire at the end of this year.

The ER Is Bursting at the Seams — Employers Hold the Key to Change

Employees visit ER “as a quick fix for their healthcare needs, particularly for mental health conditions.”

Curative Insurance Company Lands Large Florida School District

“With employees facing a 20% health-insurance increase, the Volusia County School Board has pivoted away from its longstanding carrier and awarded a $153 million contract to Curative, a startup that’s been in the business for less than three years.”

Houston’s ODPC Beats A Poke In The Eye

Houston Residents Rejoice At The News – 24/7 On Demand Health Care

Need to see a doctor but don’t want to wait days and weeks to see one? Tired of waiting in a crowded, germ filled waiting room filled to capacity with coughing and sneezing sick people whose appointment was booked for the same time as yours, all waiting to see the same doctor while snot nosed kids run around the waiting room playing grab ass?

The Most Outrageous Insurance Salesman That Ever Lived Explains How He Does It…

King Murray – The Most Outrageous Insurance Salesman That Ever Lived! is an interesting character. This video is time stamped where in two minutes he explains his secret for success…………

Build-Your-Own Health Plan

DIY and Stop Feeding the Beast

“If you’ve got access to a savvy self-funded plan backed by direct contracts or Reference-Based Pricing? Take it. That’s the best option in the country right now.”

Pass-The-Hat Risk Management

Hospital Cover Charges & Whorehouse Financing – A true story based on fabricated facts…………

A self-funded health plan that moved away from managed care networks two decades ago knows the secrets of health care finance in this country.

The PBM Survival Kit You Didn’t Know You Needed… But Absolutely Do

By Josua R

Tired of claw backs, DIR fees, and being gaslit by pharmacy benefit managers? Here’s your starter pack for surviving the daily abuse:

Insurance Tomb Stoning

Tomb Stoning is where unscrupulous insurance agents use the names of dead people and create insurance policies for them. Agents often work on large up front commissions so get money almost immediately a new policy is signed.

Does Texas HB 2015 Apply To ICHRA Plans?

And Your Answer Is…………..□ YES □ NO

ICHRA 2026

SOURCE: Venteur

One of the most notable trends in the 2026 filings is the rise of ICHRA-specific plans, which are filed off-exchange only and are priced up to 20 percent lower than their on-exchange counterparts.

$10 Admin + Cost of Risk = Current Cost/4

By Monte Jennings, President Sentia Health

Sentia has automated the entire health insurance process. We provide the EMR to practices, price the procedures 50% ABOVE Medicare, and pay for work performed in real time.

Most Americans Back Trump’s ‘Radical’ Actions To Reform Health Care Industry

The vast majority of Americans support President Donald Trump’s actions to make medical prices more transparent, according to an exclusive poll shared with The Daily Wire.

What’s This Going To Cost Me? Sorry, I Can’t Tell You!

SOURCE : Patient Rights Advocate

New national poll confirms what we’ve known all along: Americans want real prices in healthcare—and they want them before they get the bill.

Prison Inmate Health Insurance

Catastrophic Inmate Medical Insurance

Catastrophic Inmate Health Coverage

SOURCE: ACCG

Catastrophic Inmate Medical Insurance is an insurance policy with a structured reimbursement model for which eligible medical expenses incurred outside the walls of the jail can be reimbursed.

Inmate Medical Insurance

SOURCE: IAT

IAT has specialized in stop-loss insurance solutions for the adult correctional market since 1984. Our Inmate Medical program provides prisons and jails valuable protection against unknown, potentially catastrophic medical claims.

Dental Insurance For Texas Retired Teachers

Texas Retired Teachers Association (TRTA) knows Retired School Employees like you. AMBA knows insurance. Together we can provide you with the dental and vision plans you need to keep your teeth and eyes healthy now and for years to come.

Johnny’s Doctor Is a Little Strange |

Another Rojas Truth Bomb

By Dutch Rojas

Health Insurance Premiums are not high because care is expensive.

Student Accident From Chubb

SOURCE: Chubb

Many schools seek to comply with state educational code requirements and limit their general liability exposure by providing student accident insurance to students in kindergarten through 12th grade.

Capital Rx Introduces Judi

Capital Rx Expands Into Care Navigation with Acquisition of Amino Health

Through a new acquisition, Amino Health will become Capital Rx’s patient-facing care navigation solution called Judi Care.

The Employer’s Dilemma: When the Fully Insured Plan No Longer Works, What’s Next for Employers?

SOURCE: Medcity News
By Ben Light on June 12, 2025

“The results are clear, too. Recent data from Oscar Health(Opens in a new window) shows that the individual market’s vast risk pool — stabilized across over 24 million lives — has not only maintained the cost of health insurance. It’s actually forcing it down, with 2024 costs trending about 4% lower than employer costs.

The Truth About Group Health Insurance

Status Quo Health Insurance Broker Leading His Clients

By Bill Rusteberg

The Land of Lemming is better than the Land of ICHRA” is a common belief. But is it?

BCBS Michigan Sued Over Alleged Scheme to Extract Excessive Fees from Self-Insured Health Plans

Employer Sues BCBS Michigan Alleging Hidden Fees

By Mark Flores – Executive Vice President and Co-Founder at AVYM Corporation

Blue Cross Blue Shield of Michigan is under fire again—this time accused of siphoning off millions in excessive fees from self-funded employer health plans.

Doctor Explains Benefits of Fasting

TESTAMONIALS:

“When i was in college i fasted a lot, the biggest benefit i noticed was a 22% increase in ability to pay tuition”

Unintended Consequences

46 Reasons Why We Can’t Trust The Government To Do Much Of Anything

SOURCE: Sentia Health

“We compiled this list to show that we can’t have the government running any kind of nationalized healthcare program. A nationalized healthcare program like Medicare For All, Beveridge or Bismarck would encompass all the categories we just proved that the government is bad at.”

Is ICHRA a Self-funded Health Plan, or Not?

Source: Ernie Clevenger, MyHealthGuide, with initial inquiry from ChatGPT

Legally, yes, Individual Coverage Health Reimbursement Arrangements (ICHRAs) are classified as self-insured (or self-funded) group health plans because………….

Maxor Changes Name

I Wonder What Jerry Thinks About This?

I’m excited to share with you that MaxorPlus is now VytlOne as of June 9, 2025. You’ll start to see our new name immediately, and members will see our new name closer to the end of 2025.

Fiduciary Liability Insurance Is Now More Important Than Ever

A rising tide of lawsuits sweeping the nation centers upon ERISA fiduciary obligations of employers in their role as group health plan sponsors, particularly the “duty of prudence” in selecting and monitoring health plan vendors. These fiduciary failures harm plan participants and beneficiaries by paying more than they should.

Should Your Health Plan Cover Bad Behavior?

It’s Time To Put Bad Behavior Into Remission – Just Say No To Bad Behavior!

“Why should I pay for this? It’s for a $150,000 hospital bill on Lupita, our 27-year-old accounting clerk in the credit department. Tell the TPA to stop payment!” said Mr. Ruben, the owner of the company.

6th Circuit Court of Appeals Decision Potentially Rewards Billions to Self-Insured ERISA Health Plans

This ruling reinforces the importance for all self-funded ERISA health plans to understand how TPAs manage claims and compensate themselves—especially when such practices may compromise plan integrity and violate fiduciary duties.

The Great American Healthcare Heist

What Radicalized Me? (4 of 11)…………I explain this concept a bit more in this article if you want more than just this slide: The Great American Healthcare Heist: A Saga of Overpayment and Underperformance……….

School Board Member Voices Concerns With Insurance Bidding Process

Article Referred By Alex Zuniga

“Gutierrez, represented by attorney Samuel Reyes, alleges that she voiced concerns with the bidding process for insurance contracts for the district..”

We Only Want The Best For Our Employees!

“We care about our employees! We want the cheapest insurance money can buy! There’s no limit to how much we can save and we’ll spend it until we get there!” says the nice HR lady in between calls from angry plan members.

Why The Difference Between Cancer & Diabetes Treatment?

“Why do doctors and the healthcare system treat most cancers to get the patient into remission from cancer, but doctors and systems do not treat type 2 diabetic patients to achieve remission, but instead to live with the condition?” – Jeff Bernhard

Now You Have It, Now You Don’t

The enhanced premium tax credits (Welfare Assistance) are now set to expire at the end of 2025. Unless the Welfare Assistance (premium tax credits) are (is) extended, consumers can expect (Humongous) increases in both the net premium payments and gross premiums:

Are PBMs Replaceable?

“There is no such thing as an unsolved problem” – Bill Rusteberg

Know of a source that provides real time point-of-service retail pharmacy claim adjudication for self-funded health plans as an alternative to using a PBM?

When Did Blue Cross of Texas Begin Brokerage?

By Bill Rusteberg

Back in the 70’s Blue Cross of Texas sales reps were captive agents. Or were they?

Ask This Serial Claimant If She Cares

“I’m not done yet! says Mother Uganda……………….

Back in 1978 when there were only two sexes the federal government in their wisdom decided that pregnancies were the same as any other illness and should be covered by health insurance.

Blue Cross Trojan Horse

“Do not trust the horse, Trojans. Whatever it is, I fear the Greeks even when they bring gifts” – Virgil’s Aeneid, Book 2, 19 BC

Ever wonder how Blue Cross can guarantee and gift their pharmacy commissions (the politically correct term is “rebates”) as a credit applied to their administration fees? Sounds generous doesn’t it.

Are You Out Of Your Mind? I’m Not Signing This!

By Bill Rusteberg

PBM Agreements are Contracts of Adhesion and it’s nearly impossible to negotiate contract language and terms. “Take it or leave it!” says the PBM. “We have enough fools accepting these contract terms so go pound sand if you don’t like it!”

The Good Old Days

Photo Referred By S. McDaniel

Lung cancer patients says “What the hell, I’ll take a pack of non-filtered Camels please! And charge it to the room………..”

Meanwhile his surgeon prepares. Next day in the operating room…………

Sidney’s Image

Image By Sidney Haitoff

Sidney’s Image is proof a picture is worth a thousand words. Sidney’s Image explains the difference between the failed legacy health plans of the past 40 years and all the value draining third party baggage it brings versus New Era Healthcare that’s disrupting healthcare delivery, finance and access in far better and more cost effective ways than proponents of more government control have ever dreamed about in deep sleep stupor.

Viva Kennedy!

The Rise and Fall of a Controversial Health Insurer

SOURCE: ActivityCovered.com

Salvasen Health burst onto the health insurance scene in 2020 with big promises of affordable, comprehensive health coverage. However, behind the glossy marketing was an illegal operation that left thousands of customers without the coverage they paid for.

Should Primary Care Be Covered By Insurance?

“Insurance is designed for catastrophic events, not for low-cost events. We don’t buy Flat Tire Insurance, or Fan Belt Insurance. So why do we buy Primary Care Visit Insurance? – Don Pedro

Hospital Wants To “Discharge” Man Who’s Been In Hospital For Nine Years

Hospital’s cost saving discharge strategy hinges upon patient attaining room temperature

DO WE HAVE THE STOMACH TO CUT HEALTHCARE COSTS?

By Jeff Evans

DO WE HAVE THE STOMACH TO CUT HEALTHCARE COSTS?

Everyone complains about the high cost of healthcare and health insurance. But can you really complain if you’re not willing to do something about it.

Public Procurement: Late Is Late

“Why do something today when it can be done tomorrow!” – Don Pedro

Frontier Direct Care Celebrates 2025 First Quarter

Revenue: $3.9m – Contracted Members: 19,450 – Clinic Count: 9 – Medical Staff Count: 52

NSA Boondoggle Continues

Getting A Second Bite At The Apple: When you win but lose, keep fighting until you win and don’t lose…..

Another Truth Bomb By Rojas

By Dutch Rojas

The Physician Shortage: Arithmetic, Incentives, and the American Delusion

The $362.50 Defined Contribution Health Plan

“If a large employer sponsors a defined contribution plan such as an ICHRA to all full-time employees and contributes $362.50 per participating employee per month the employer’s cost will be never more than $362.50 per employee whether the employee’s share of the cost is affordable or not.”

Jeremy’s Solution For GLP-1 Health Care Financing

Jeremy Bentham (1748–1832)

A 450 life self-funded health plan spends more than $1.5 million GLP-1 drugs, or about $300 pepm benefiting 20% of plan members. A majority of plan members don’t benefit at all.

How To Sell Group Long Disability Income Insurance In Under 1 Minute

Insuring worker’s paychecks has never been easier. Field quoting rate estimation is not rocket science.

Back in the day when delivering health insurance renewals I would always ask “Mr. Employer, do you insure your employee’s paycheck?”

When the answer was invariably “No” I would say “We can insure all your employee’s paycheck that will pay them 2/3 of their income all the way to age 65 after a 90 day waiting period for less than 1% of your payroll.”

A Little Dab Will Do Ya!

Why Some People Are Microdosing Popular Weight-Loss Drugs

San Antonio Providers Known To Accept RBP Patients

San Antonio is a mature Reference Based Pricing market. The first group adopting RBP did so in 2007. More followed over time as word spread throughout the business community of savings to be achieved.

Memorial Day – Remembering The Liberation of Dachau

A letter to his children by Col. E. Rusteberg dated 28 September, 1989

There it was, on his cap, the “Death Head” of the SS Toten Kopf, the dreaded and most feared of Hitler’s ruthless legions.

Memorial Day 2025

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

Here’s A Provider Contract That Will Lower Your Health Care Costs By +50%

You are a third party beneficiary to provider contracts someone else you’ve never met negotiated. You have no clue what you have agreed to pay for care………… and no one tells you…… until you pay for care.

Your group health insurance costs go up double digits every year, year after year. You think there is nothing you can do to bring health care costs down because your broker thinks the same. You are mistaken………….and so is your broker. (Read on, it gets better)……

The House Republican Budget Reconciliation Legislation: Unpacking The ICHRA And HSA Changes

Katie Keith – May 22, 2025

If enacted, the House bill would severely cut federal health care spending—including the most significant cut to the Medicaid program in its 60-year history—and highly restrict eligibility for marketplace coverage. Those proposed changes are summarized here.

The Art Of The Deal

By Leon Wiesnieski

Yesterday I had to schedule a MRI on knee for my son. I call the hospital outpatient services and schedule. They ask “what insurance do you have”. I said none, I’m self-pay. They schedule me and tell me another person will call me to tell me the price. 1hr later I get a phone call telling me the price is $242.

Building a Health Insurance Company that WORKS

Everything you need to know to save health insurance in the United States and the world

By Monte K. Jennings

Modern Medicine, Step By Step

By Liie Jarrouge, MD

Got high blood pressure? Here’s a pill.