Archive for the ‘Uncategorized’ Category

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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You People 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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Austin ISD Gifts $12,000,000 – Uncle Sam Rejoices

Saturday, February 13th, 2021

Texas school district makes a one time gift of $12,000,000 to be split between employees and Uncle Sam in an effort to bribe employees from leaving for greener pastures. This is the same district that closed down schools last year and laid off workers due to rising health insurance costs.

Would it have been better to fund a Health Savings Account for all employees instead? Of course Uncle Sam would get nothing in that case while the employees would gain ownership of the entire $12,000,000 gift, tax free, forever………………

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There’s A Rate For Any Risk

Saturday, February 13th, 2021

This photograph from 1921 shows Millicent Woodward, a lady who took out a policy at Lloyd’s of London that year.

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Only Idiots Burn Bridges

Friday, February 12th, 2021

Last week we witnessed an idiot burn down a bridge. Fire department investigators reported the bridge beyond repair.

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New Health Plan For Texas Educators

Thursday, February 11th, 2021

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

Public Consulting Group’s (PCG) Texas ISD HealthPlan is an innovative, new healthcare program designed specifically for Texas Independent School Districts (ISDs), Texas teachers, and their covered family members.

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Beware! Covid19 Vaccine May Change Your Sex Life

Wednesday, February 10th, 2021

“Don’t go near those who have had the COVID vaccine,”  warned the official,  “They have become …………!”

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Texas Insurance Code – Chapter 541 Unfair Methods Of Competition And Unfair Or Deceptive Acts Or Practices

Tuesday, February 9th, 2021

Molly Mulebriar, investigative reporter from Warring, Texas, is currently winding up her investigative report of a Texas TPA’s efforts to boycott a competitor in violation of the Texas Insurance Code.

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Confessions of A Reformed Health Insurance Broker

Monday, February 8th, 2021

A lot has changed since I entered the world of health care benefits in 1973. The journey has been fascinating………………

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HB 1646

Monday, February 8th, 2021

Relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans……………….

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Aldeen The Magnificent

Monday, February 8th, 2021

Doug Aldeen – RBP Defender Warrior

Doug Aldeen (The Magnificent), an ERISA attorney, talks about Reference Based Pricing and what he does to help plan sponsors in that space. This is a guy you want in your corner……………….

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HB 1649

Sunday, February 7th, 2021

Relating to bids or proposals required for insurance and risk pool contracts entered into by a school district, municipality, or county.

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School District Sues Health Insurance Agent for $1 Million

Sunday, February 7th, 2021

Lawsuit accuses the health insurance agency of trying to defraud the district……..This impoverished Texas school district is a plaintiff’s lawyer’s dream come true……………lawsuits fly left and right over the past decade……………..Meanwhile back in the classroom……………..

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You’re Making How Much!

Saturday, February 6th, 2021

A school district in deep South Texas was paying their benefits consultant $614,000 per year but didn’t know it.

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Texas Senate Bill 376

Friday, February 5th, 2021

Relating to registration and annual filing requirements for governmental units establishing a self-insurance fund.

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North Korea Mandates Insurance For the Masses

Wednesday, February 3rd, 2021

People React With Joy At The News

“Insurance plays an important role in realizing the politics of love for the people.”

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Monday, February 1st, 2021

Promising New Chinese Flu Test

Monday, February 1st, 2021

“To collect test samples, the swab needs to be inserted about three to five centimeters (1.2 to 2 inches) into the rectum and rotated several times………….”

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CPO

Monday, February 1st, 2021

Engage, Pay Less, Get Rewarded………………………..

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Texas HB 1490 & The Lisa Plan

Sunday, January 31st, 2021

House Bill 1490 would require Texas hospitals to post cash prices for their services……….

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Will The Texas Legislature Prohibit TRS ActiveCare Alternatives?

Saturday, January 30th, 2021

In order to protect TRS ActiveCare, the Committee on Pensions, Investments, & Financial Services recommended in their interim charges that the 87th Texas Legislature take action to “explicitly prohibit independent school districts from using District of Innovation status (as) a method for opting out of TRS-ActiveCare.”
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TRS ActiveCare’s Hostage Taking Strategy Under Attack

Saturday, January 30th, 2021

“He who has data wins. He who has good date wins a lot. He who has real time data wins all the time.” – Author Unknown

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Tenent’s Second Bite At The Apple

Saturday, January 30th, 2021

As  some of you in our space may be aware we have recently noticed Tenent is aggressively going after RBP accounts across the country seeking the difference between billed charges and plan allowable despite accepting RBP patients, taking an Assignment of Benefits, and cashing benefit checks.

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The Amazon Solution To Rising Health Care Costs

Friday, January 29th, 2021

Amazon knows robots don’t need health insurance but people do. A robot can be programed to do what people do while people can’t ever be programed to perform flawlessly time and time again. Robots are never late for work, never complain, don’t steal, and work tirelessly 24/7.

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Texas Legislature – Three Bills Worth Watching

Wednesday, January 27th, 2021

The Texas legislature meets biannually and is now in session. Here are three bills worth watching……

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The Truth About The Shot

Tuesday, January 26th, 2021

 Simone Gold, M.D.

Simone speaks the truth about the Wuhan virus (politically correct term is Covid-19 – we don’t want to offend the Chinese do we?)

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Texas School District Saves $530,457 By Replacing Agent of Record

Sunday, January 24th, 2021

Texas school district saves $530,457 by replacing their health insurance Agent of Record after previously awarding her $1.8 million plus an 8 year contract worth +$60,000 per month.

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How To Turn A $3,500 Employee Benefit Into A $25,000 Equivalent

Saturday, January 23rd, 2021

The Bang Bang Health Plan

An Arizona county employee benefit plan has found a way to effectively turn a $3,500 employee health benefit into a $25,000 equivalent by crossing a manmade line in the desert………………. (more…)

PUBLIC-PLAN OPTION

Friday, January 22nd, 2021

It’s been less than 24 hours from yesterday and noise from Washington suggests changes in the way American healthcare is financed and delivered may be imminent………..

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Pricked

Tuesday, January 19th, 2021

The price of diabetes related medicines should be an American embarrassment……………

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The La Joya ISD Shit Show Continues………………..

Tuesday, January 19th, 2021

Texas insurance agent stands to gain $68,375.00 per month for the remainder of the original term of the agreement if her eight year  consulting / brokerage agreement with a Texas public school district is canceled for “any reason.” 

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Texas Senate Bill 120 – A Gift to ICHRA’s?

Monday, January 18th, 2021

If passed, this could make ICHRA’s even more attractive to employers who are tired and fed up with all the hassles of providing group health insurance for their employees along with the ever present threat of punishing government sanctions. 

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Texas House Bill 573 – Health Care Sharing Ministries

Monday, January 18th, 2021

If Texas House Bill 573 passes this legislative session Health Care Sharing Ministries will be prohibited from certain advertising such as touting their financial strength and past performance to provide health care benefits for their members…………… even if its true!

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Texas To Consider Single Payer Health Plan

Monday, January 18th, 2021

TEXAS HEALTH INSURANCE BROKER

Texas health insurance brokers who find themselves in the unemployment line by way of passage of HB 602 will be able to retrain for other careers through state provided funding. 

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Discounts Don’t Matter

Saturday, January 16th, 2021

Medical discounts are a scheme used by health insurance companies, service providers, hospitals, and others in the medical supply chain to show “value” to their customers. “Look at how much we saved you! Aren’t you happy you choose us as your partner! Just imagine what you would have paid without us!”

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PPO Network Gobbles Up RBP Vendor

Friday, January 15th, 2021

MultiPlan Corporation to Acquire HST

  • Accelerates Growth by Adding a Next-Generation Reference-Based Pricing Program to the MultiPlan Solution Suite
  • Acquisition is the First Under MultiPlan’s Enhance-Extend-Expand Strategy
  • Increases Value for Customers by Adding New and Complementary Services to Better Manage Cost
  • Deepens MultiPlan’s Penetration in the TPA/Broker Segment

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Nonprofit Hospitals Are Biggest Rip Off In America

Friday, January 15th, 2021

All across the nation, cities big and small are having their pockets picked and their communities decimated by their local nonprofit hospitals.

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Teachers Union Demands Lids on All Toilets

Thursday, January 14th, 2021

Fear of public toilets is nothing new and surprisingly common. But is COVID by toilet really a thing?

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The Power of Incumbency During A Pandemic

Thursday, January 14th, 2021

By Molly Mulebriar

Third party administrators (TPAs)  have always enjoyed the power of incumbency and it has never been greater than now.

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Mark Cuban Cost Plus Drug Company

Thursday, January 14th, 2021

The Mark Cuban Cost Plus Drug Company is dedicated to producing low-cost versions of high-cost generic drugs. We pledge to provide radical transparency in how we price our drugs.

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The Cost of U.S. Healthcare Shocks Brits

Wednesday, January 13th, 2021

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Medical Insurance in China

Wednesday, January 13th, 2021

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Chinese Government Encourages Private Health Insurance

Wednesday, January 13th, 2021

China’s Communist party rolls out pilot tax benefit plan in hopes to expand private health insurance because the government’s plan is not good enough…………….

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The San Antonio Free Market Medical Association

Tuesday, January 12th, 2021

Organized in 2019, Roger Moczygemba, MD and Shankar Poncelet came together with other thought leaders in the San Antonio community with the goal to lower the cost of healthcare in San Antonio through price transparency, reference-based pricing, and local connection.

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Cameron County Texas Seeks Insurance Consultant

Tuesday, January 12th, 2021

Cameron County is seeking a qualified fee based insurance consultant to assist the county in a competitive RFP process for group health insurance for county employees. 

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New, Competitive Dental Plan Hits The Market

Tuesday, January 12th, 2021

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Government Initiates Broker Disclosure Requirement

Monday, January 11th, 2021

Wanna hear about the broker who was making $614,000 on a South Texas 2,500 life school district while the clueless Board of Trustees thought the compensation was $128,000?.

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Blue Cross To Punish Republicans

Monday, January 11th, 2021

Politicians Chase Dollars To Remain In Power

Blue Cross, punching down, has announced they will no longer share member’s premium dollars with lawmakers except for those who pledged allegiance to Joe Biden…………….

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Healthcare Isn’t Expense – Price Gouging Is

Monday, January 11th, 2021

Healthcare isn’t expensive. It’s price-gouging and profiteering that is expensive and straightforward to eliminate………………..

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Question for RBP “Experts”

Thursday, January 7th, 2021

If hospitals are required to publish their prices and they have patients sign agreements wherein the patient agrees to pay “in accordance with the regular rates and terms of the hospital” which are public for the world to see, what defense does the patient, who assigned benefits, have in disputing full billed charges when the average reimbursement accepted through the hospital’s payer mix is substantially less?

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Contracts of Adhesion

Thursday, January 7th, 2021

An adhesion contract (also called a “standard form contract” or a “boilerplate contract“) is a contract that heavily restricts one party while leaving the other free (as some standard form printed contracts); implies inequality in bargaining power

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If A Health Plan Could Be A Person……………..

Tuesday, January 5th, 2021

Dave Chase

In this era where healthcare has been politicized (a great way to freeze status quo), I’m happy to report that Health Rosetta’s core tenets draw agreement from both ends of the political spectrum. They spell out HEALTH.

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Hyped Start Fizzles

Monday, January 4th, 2021

The Gang Disbands

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

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Famed Magician Reveals How To Create Rx Savings Out of Thin Air

Monday, January 4th, 2021

The cost for a Fully Insured Rx Card is 8-10% of the plan cost. So, if the Stop Loss Carrier carves out 15% for the Rx and the cost for the Fully Insured Rx Card is 10%, you’ve just cut the price of the group plan by 5%. 

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Hapless Plan Sponsors Are Screwed By Switch Operators

Monday, January 4th, 2021

A ‘Switch Operator’ is a Software Clearinghouse Between a Pharmacy and a PBM that Allows the Pharmacy to Check the Patient’s Drug Formulary, Copay and other Insurance Information.

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Texas County Believes All Health Care Is Local

Sunday, January 3rd, 2021
All health care is local, or at least it ought to be………………….So why do most plan sponsors hire out-of -state plan management firms like UHC, Humana and the rest? They just get in the way…………………..

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Excellent 7 Minute Video Explains The Past & Possibly The Future

Saturday, January 2nd, 2021

This is one of Dr. Bricker’s best videos. In 7 minutes he puts the current economic status of healthcare in historical perspective.

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Let The Sun Shine In………………..

Thursday, December 31st, 2020

Effective in 2021, employee benefit plan fiduciaries will be required to get fee disclosures from service providers…………..this means hidden fees earned by many brokers (especially the large national brokerages) must be disclosed to newly horrified plan sponsors

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Employers Choice Rx Adopts RBP Approach

Thursday, December 31st, 2020

Traditional PBM Representative Reacts 

In 2011 when the Employers’ Advanced Cooperative on Healthcare founded Employers’ ChoiceRx (ECRx) it was the first pharmacy BENEFIT solution built to be a transparent/cost-plus program that focused on “therapeutic equivalent” drugs to achieve a lowest net cost reference price.

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SmartHealth PayCard

Thursday, December 31st, 2020

Approved cardholders receive immediate access a revolving credit line of up to $30,000 to pay for covered health care expenses……………….

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Professor Aldine Updates SAT Test

Wednesday, December 30th, 2020

Professor Doug Aldine updates SAT test question/s for wannabe college students hell bent on achieving little by way of a college degree…………….

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Infections Disease Racial Disparities Task Force

Wednesday, December 30th, 2020

Pitting Hyphenated Americans against each other using health care as a political tool to do so……………………

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Holy Cow!

Wednesday, December 30th, 2020
“The pharmacy benefit managers are not going to like what we are doing when it comes to ScriptCo.”

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TRS ActiveCare Update

Tuesday, December 29th, 2020

Districts of Innovation offering competing health plans have impacted TRS membership this year. Market intelligence tells us one of the new competing health plans has captured approximately 12,000 employee lives with a total of 17,000 members………….

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Killing Chinese Flu Virus In 30 Seconds

Monday, December 28th, 2020

Lone Ranger Rejoices – No More Mask!

Researchers from Tel Aviv University have proven that the Chinese Flu virus can be killed efficiently, quickly and cheaply using ultraviolet light-emitting diodes……..all in 30 seconds…………

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P&C Brokerage

Monday, December 28th, 2020

In-sur-ance (in-shoor’ens) n. 1.a. The act, business, or means of insuring persons or property. b. The state of being insured. 2. A contract binding a company to indemnify an insured party against specified loss. 3. The sum of which something is insured. 4. RiskManagers

Insure (in-shoor’) v. – sured, -suring. 1. To protect against loss, damage, etc. with insurance. 2.  Also ensure (en-). To insure n. RiskManagers

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To Comply or Not To Comply, That Is The Question

Monday, December 28th, 2020

Hospitals Hate Pricing Transparency

Hospitals failing to comply will be subject to a chump change fine not to exceed $300 per day ($109,500 per year). Plus the government will attempt to embarrass non-complying hospitals by posting notice of the penalty on the government’s CMS website for all the world to see and marvel……..

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Providers Find Silver Lining in “No Surprises Bill”

Sunday, December 27th, 2020

Why would any provider want to be in-network if they know they will always get more than what a plan pays?

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Government Acts Against Money Interests – Sides With The Common Man

Friday, December 25th, 2020

Andrew Jackson – Champion of The Common Man

After years of being stymied by well-funded interests, Congress has agreed to ban one of the most costly and exasperating practices in medicine: surprise medical bills……………

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Oscar Health – San Antonio Market Rates

Thursday, December 24th, 2020
Under new ICHRA’s employers can pay the cost of individual health insurance plans like Oscar Health . See Oscar’s San Antonio area benefits and rates for 2021.

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