Archive for the ‘Uncategorized’ Category

Invoice-Based Drug Reimbursement Does Not Cut Spending?

Tuesday, July 14th, 2020

Rather than basing Rx pricing by applying a discount off arbitrary sticker prices the strategy is to base pricing off what retail pharmacies pay for drugs. For example, if a pharmacy pays $10 for Drug A, the plan sponsor pays $10 plus a margin. This is Reference Based Pricing for Rx claims. But according to the following article this strategy does not save money. The American Rx pricing mystery continues…………….

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Supreme Court Issues Half Pregnant Ruling

Sunday, July 12th, 2020

Celebrating Too Soon? Wait Until November 3…………

“The court sent the case back to a lower federal court for further action, inviting additional challenges………………”

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Texas Rebellion

Friday, July 10th, 2020

Lone Ranger Refuses To Wear Mask in Solidarity 

“I think it’s an insult to Texans to be required to do something they should have discretion for,” said Hugh Reed

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Texas Bans Tummy Tucks

Friday, July 10th, 2020

Texas expands elective surgery ban to more than 100 counties

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Non-Compete Clauses Hurt Both Doctors & Patients

Friday, July 10th, 2020

Big Medicine would love to trap your doctor in their job, even if it’s abusive.

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Sex Sells – Winning Sales Quota by Banging Doctors?

Thursday, July 9th, 2020

In 2012, Insys hired a new sales executive: Sunrise Lee, a Florida escort service manager and former strip club dancer with no academic degree, according to Guzman’s complaint. Burlakoff allegedly defended the decision, claiming, “Doctors really enjoyed spending time with her and found Sunrise to be a great listener.” He added, “She’s more of a closer.”

The regional sales manager reported that the new employee was “dumb as rocks, but that she was sleeping with another doctor and getting a lot of prescriptions out of him.”

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Texas Sheriffs Refuse To Arrest Tonto

Thursday, July 9th, 2020

Look Kemosabe, Greg’s Pulling His Hair Out!

“The order is not a law, there is no requirement that any police officer enforce it, and it’s unenforceable. We can’t spend our time running from place to place for calls about mask we can really do nothing about.”

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West Texas Doctor Says We Are Treating Covid 19 Wrong

Wednesday, July 8th, 2020

SOURCE: Mike Reagan on Linkedin

“This West Texas doctor says he has a low cost cure for Covid-19 (Budesonide), we don’t need a vaccine and the “stay at home, shut down businesses mentality” is politically motivated. He further states that the way we are treating Covid is wrong.”

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Government Bureaucrats Change Rules – Are You or Are You Not?

Tuesday, July 7th, 2020

Plan sponsors should determine whether they are a “covered entity” as newly defined under the final rule for nondiscrimination purposes. If not Katy-Bar-The-Door for out-of-the-box risk management strategies……..

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Radiology Reading Is Not A Perfect Science

Sunday, July 5th, 2020

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RiskManagers Interlocal Purchasing Cooperative

Sunday, July 5th, 2020

RiskManagers Interlocal Purchasing Cooperative is designed for Texas political subdivisions seeking alternatives to traditional managed care health insurance plans.

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The Villains of Health Care

Saturday, July 4th, 2020

“This first article in a three part series will focus on Pharmacy Benefit Managers – one of the three most influential opponents of price transparency.”

Twenty years ago Express Scripts was a $1 Billion revenue company, but now they have over $100 Billion in revenue per year.  No inventory to trouble with, no warehouses needed, no fleet of trucks to maintain………………the only thing needed are contracts of adhesion cleverly designed to screw third party beneficiaries……………………………..

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Lasers Killed My Health Plan

Friday, July 3rd, 2020

All the proper reserving in the world may not cure a severe case of lasers. The Great Laser Pandemic is running rampant, striking angst and fear among plan sponsors everywhere.

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We Won, We Won!

Wednesday, July 1st, 2020

Great news: We and our partners at CBS News won the 2019 Society of Professional Journalists – Sigma Delta Chi Public Service gold medal for network news for our health costs partnership, “Medical Price Roulette.”

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Underwriting Medical Plans The Old Fashion Way

Sunday, June 28th, 2020

These are the tools of the trade a 72 year old industry dinosaur uses to underwrite group medical plans, projecting future costs, rate setting, reserve requirements, quantifying IBNR, etc.

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Xerox, Eastman Kodak And Cost Plus Insurance

Saturday, June 27th, 2020

Xerox, Eastman Kodak And Cost Plus Insurance

“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg

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A “Must Have” for Health Care Disruptors

Thursday, June 25th, 2020

Works on Brass But Not on Walnuts

When asked recently during a question and answer period at a symposium I attended, a member of the audience asked “What do you tell employers who voice concern about some of your strategies to reign in health care costs?

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The Largest Cartel We All Unknowingly Participate In

Thursday, June 25th, 2020

Pssst, God Father, Justin’s At It Again!

Cartels: “an association of manufacturers or suppliers with the purpose of maintaining prices at a high level and restricting competition………………

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Hospitals Sued to Keep Prices Secret. They Lost.

Thursday, June 25th, 2020

Let the Sun Shine In…………………………………………………………

This will be the end of PPO networks and will turbocharge the explosive growth of Reference Based Pricing strategies…………………..

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Specialty Drug Risk Transfer Strategy – The Hot Potato Method

Wednesday, June 24th, 2020

SPECIALTY DRUG MANUFACTURER

The best method to transfer risk is to stop paying for it………………………….

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Statue of The Week – Robert E. Lee

Tuesday, June 23rd, 2020

RiskManagers.us celebrates our country’s rich historical past with this new, weekly series of STATUE OF THE WEEK………………..

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David Belk Opines

Tuesday, June 23rd, 2020

Dr. Belk gives a talk to One Payer States, a group advocating for a single payer system…………

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You Have Got To Be Kidding!

Saturday, June 20th, 2020
“Hospitals claim that hiding prices allows them to offer large discounts to insurance companies.” Then why do Hospitals Dismiss Significance Of Chargemaster Prices?

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$50 Million Prescription Drug Scam

Thursday, June 18th, 2020

Authorities said Hickman and the others recruited public-sector employees who were paid to get prescriptions they didn’t need and hadn’t been prescribed. Among the more than two dozen people who have pleaded guilty was John Gaffney, a Margate-based doctor who admitted signing prescriptions for patients he never saw………………..

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Fuzzy Math & Missing Dollars

Wednesday, June 17th, 2020

Tom, Dick and Harry on the way to a conference decided to stop along the way and get a hotel room. It was late at night, but they saw in the distance ahead a hotel with a neon sign that said “Vacancy.”

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Top Disruptor 50 Companies

Tuesday, June 16th, 2020

In the eighth annual Disruptor 50 list, CNBC identifies private companies whose breakthroughs are influencing business and market competition at an accelerated pace. They are poised to emerge from the coronavirus pandemic with tech platforms that have the power to dominate.

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El Paso ISD Health Insurance Update

Monday, June 15th, 2020

The El Paso Independent School District was the second public school district to challenge TRS ActiveCare in 2019 by offering employees a commercial health plan option in direct violation of TRS ActiveCare mandate prohibiting Texas school districts from doing so. So how has the commercial plan option fared financially so far?

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Texas County Seeks TPA Proposals

Monday, June 15th, 2020

San Patricio County is seeking proposals for TPA services to be effective January 2021. San Patricio County was the first political subdivision in Texas to adopt Reference Based Pricing more than ten years ago.

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Recovered Chinese Flu Patient Racked By Guilt

Saturday, June 13th, 2020

Man Racked By Guilt Complex – Scientists determine post recovery symptoms may require lifetime counseling………………..

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Money Bucket Strategy Solves Employer Sponsored Health Care

Thursday, June 11th, 2020

99% of traditional health plans offer no incentives to shop for best prices and outcomes. Doesn’t matter where an insured goes, the same patient responsibilities apply. The same deductible, same co-pays, same maximum out-of-pocket costs.

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Putting Healthcare First – A Video Journey By David Contorno

Wednesday, June 10th, 2020
Giving employees daddy’s unlimited credit card and telling them they can go anywhere they want for treatment and their out-of-pocket expense will be the same no matter where they go or who they see, is the dumbest thing employers can do to their employees.

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9 Ways Chinese Flu May Forever Upend U.S. Health Care Industry

Wednesday, June 10th, 2020

Pay particular attention to #2,. ICHRAs make sense for employers who are tired of fighting health care costs every year, dealing pesky insurance salesman all while at risk of government punishment should they misstep along the way…………..ICHRA’s Shake Up Market

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Willis Towers Watson Faces Shareholder Lawsuits in U.S. Over Sale to Aon

Tuesday, June 9th, 2020

The suits allege that Willis and its directors breached their fiduciary duties under U.S. securities laws by filing incomplete and misleading information with the Securities and Exchange Commission on the transaction.

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Reference Based Rx Pricing

Monday, June 8th, 2020

PBM’s have traditionally used Average Wholesale Price (AWP) and Maximum Allowable Cost (MAC) as pricing benchmarks. Now there is another method……………..

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Texas Businessman Says “Send Me All Your Covid 19 Patients!”

Monday, June 8th, 2020

“Telemedicine has advanced ten years in only two months.” – Gilberto ‘Beto’ Garcia, Jr

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The Rise of TeleHealth

Friday, June 5th, 2020

Telehealth claim lines increased more than 4,000% in the past year………………

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Sedera Demonstrates What Health Insurance Should Really Cost

Friday, June 5th, 2020

Remove third party barriers to care and guess what? Presto, you’ve just solved health care………..

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United HealthCare Producer Compensation

Thursday, June 4th, 2020

We believe it is important that our customers understand how these independent producers are compensated, so we offer this overview of our producer compensation programs.

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BCBS Special Broker Bonus Program

Thursday, June 4th, 2020

Earn a total bonus of up to $24,000 with the BCBSTX Grand Slam Bonus Program!

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Doctors Smoke More Camels Than Any Other Cigarette

Tuesday, June 2nd, 2020

UHC & Houston Methodist Cat Fight Ends

Monday, June 1st, 2020

We all knew how UHC vs Houston Methodist  cat fight would eventually turn out. This type of thing happens all the time, going all the way back to the previous century. No one knows what these cats have agreed to as far as what we all will end up paying for health care. Neither side wants you to know and therein lies the basis of their shared interests……………..

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Reference Based Pricing + DPC = Up To 40% Savings

Monday, June 1st, 2020

Payer Compass’s reference based pricing plus direct primary care can reduce plan costs by up to 40%.

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Monday, June 1st, 2020

Employers Pay Brokers BIG BUCKS but Most Don’t Know It

Sunday, May 31st, 2020

“A broker can “power up” the bonus to $150,000 per employer group……Commissions of 3 to 6 percent of the total premium……could be about $50,000 a year on the premiums of a company with 100 people, payable for as long as the plan is in place. ……Commissions can be even higher, up to 40 or 50 percent of the premium, on supplemental plans that employers can buy to cover employees’ dental costs, cancer care or long-term hospitalization…………..Bonuses…..as much as $100,000 per group, and “there’s no limit to the number of bonuses you can earn.”

Health Care Service Corporation, which oversees Blue Cross Blue Shield plans serving 15 million members in five states, disclosed in its corporate filings that it spent $816 million on broker bonuses and commissions, about 3 percent of its revenue that year.

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Brokers Get Paid For The Work They Don’t Do

Saturday, May 30th, 2020

Driving across town to earn $87,000 is one hell of a way to make living…………..

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Willacy County Seeks Competitive Proposals

Friday, May 29th, 2020

Willacy County is seeking competitive proposals for: Employee Medical, RX, Dental & Vision plan

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Breaking Down Where All The Money Goes

Thursday, May 28th, 2020

According to this illustration, the following statistics can be derived:

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Restoring Medicine

Wednesday, May 27th, 2020

We are a grassroots movement of doctors, nurses, students, business leaders, and everyday citizens from across the United States that are demanding a more honest and fair health care system.

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Government Mandates Health Plans To Cover $25,000 Drug

Tuesday, May 26th, 2020

Government mandate forces health plans to cover Truvada, the only FDA approved drug used to prevent HIV. Annual cost of this drug is $25,000…………………

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Texas School Districts Run Out of Money

Tuesday, May 26th, 2020

School districts will be forced to reexamine finances including health care spend……………….

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TRS ActiveCare

Tuesday, May 26th, 2020

2019 Annual TRS-ActiveCare Financial Report

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Fascinating Insurance Meeting

Tuesday, May 26th, 2020

If you have a spare 2.5 hours, this is worth watching…………………………

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Memorial Day 2020

Thursday, May 21st, 2020

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

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Molly Mulebriar Exposes PPO Kickback Scheme

Thursday, May 21st, 2020

Do the PPO Kickback Scheme described in this July 2011 blog posting still exist…………..?

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The End of the Game

Thursday, May 21st, 2020

I don’t speak German, but I think she said: “What The F**k?!”

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20 Ways to Negotiate Your Bill

Thursday, May 21st, 2020

If collectors are calling you insisting that you pay for an unfair bill, insist they provide you with the contract obligating you to pay. Without a written agreement that you owe money, you have no legal obligation to pay………………

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What Ever Happened To Martinsville Hospital vs Glenn M. Dennis?

Wednesday, May 20th, 2020

Reference Based Pricing Lawsuit Grabs National Attention

“Few of us, when confronted with the threat, ‘Your money or your life! ’ would, like Jack Benny, pause and respond, ‘I’m thinking, I’m thinking.’ Most of us would empty our wallets. Does that act of acquiescence demonstrate acceptance of an offer and create a contract?”

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Opportunity Beckons – Will RiskManagers.us Take The Bait?

Monday, May 18th, 2020

Ready to be your own boss? You have what it takes to become a GEICO Local Agent! As a GEICO Local Agent, you’ll write business for GEICO and our affiliates as an independent, small business owner, right in your own back yard.

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Overcoming Misconceptions About Healthcare Benefits: Part 4

Monday, May 18th, 2020

Posted by: 

Albert Einstein knew that the quality of a solution was directly related to a person’s ability to identify the problem they were trying to solve. He famously said, “If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and five minutes thinking about solutions.”

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The Mystery of Drug Pricing

Monday, May 18th, 2020

Our Clearinghouse ModelSM simplifies drug pricing and frees up resources to improve patient care. Sometimes a simple change delivers revolutionary results…………..

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Hospitals Shun Sunshine – Embrace Foggy Days

Monday, May 18th, 2020

“We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms,” the group said in a statement………….

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ICHRA’s Shake Up Market

Sunday, May 17th, 2020

Your broker advisor will probably never recommend ICHRA’s because to do so will destroy their business model. That’s probably why you’ve never heard about ICHRA’s until now……..

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Saturday, May 16th, 2020

Q4intelligence is a business, sales, and marketing consulting firm working with insurance and benefits agencies.

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The Maestronites

Saturday, May 16th, 2020

We are Maestronites, and our people are at the core of what we do.  We value an innovative approach, a drive to disrupt, an enthusiasm towards making a difference, and most importantly, a passion to make employee health & benefits “people-friendly” again.

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The Evil LASER MONSTER Is Waiting For You

Saturday, May 16th, 2020

Evil LASER MONSTER waits for you from the darkness of stop loss hell………………

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A Speech Worth Watching

Friday, May 15th, 2020

Approximately 4 minutes long, this man delivers a powerful message with meaning for everyone

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Higginbotham Acquires Obscure San Antonio Agency

Friday, May 15th, 2020

“Hi, I’m from Amerman Insurance Services, may I come over to talk to you about insurance this afternoon?”

Amerman? Never heard of you. Goodbye……………..

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A Llama Named Winter

Wednesday, May 13th, 2020

A Llama Named Winter May Hold the Key to a Coronavirus Treatment

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The Klement Letter

Tuesday, May 12th, 2020

“As an outsider looking in and not having all the political implications and considerations that board members face, I’d like to give you our perspective and advice for consideration on your choices.” – Greg Klement

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School District Believes In The Tooth Fairy

Tuesday, May 12th, 2020

The Weslaco Independent School District believes insurance agents are so invaluable they hired three of them……….”At no cost to the district”……and they are getting the TPA for free too………. 

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Hoax RFP From The Past

Tuesday, May 12th, 2020

mulebriar

Financially strapped district leaves +$500,000 on the table……………..

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“Hoax” RFP

Tuesday, May 12th, 2020

Former Amarillo Mayor, Fairly Group CEO file lawsuit against Amarillo ISD

“This suit does not seek to recover monetary damages from AISD. I am simply ‘raising my hand’ to shed light on a process I believe is flawed and unfair to Amarillo’s teachers and taxpayers.” – Alex Fairly

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Meet New Texas Medical Association President-Elect

Monday, May 11th, 2020

Linda poised to be the next president of TMA representing more than 53,000 doctors in Texas………………….

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El Paso ISD Report Card – First Year Renewal After Challenging TRS ActiveCare

Saturday, May 9th, 2020

“The CIGNA plans continue to offer better benefits with greater freedom of choice and fewer restrictions than TRS at competitive deductions along with its annual contribution to the Health Savings Account.”

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Guarantee “No Laser” Contract

Saturday, May 9th, 2020

Guarantee “No-Laser” Contract – We guarantee not to raise the specific deductible relative to an individual at renewal who may be experiencing on-going claims.  Additionally, the terms for the renewal will not represent a premium increase which includes the entire expected cost of a known future excess claim.

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