Archive for the ‘Uncategorized’ Category

Why The Outrage Now!

Thursday, April 2nd, 2020

We’ve seen little or no outrage over egregious hospital price gouging in years past. Consumers have remained complacent. Yet now we are seeing outrage over minor things like $60 for a bottle of hand sanitizer, or $39.95 for a pair of face masks. Why the outrage now when there was none before?

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A Reference Based Pricing Vendor With A Difference

Thursday, April 2nd, 2020

            Alex Fairly

No other RBP vendor can replicate our simple, streamlined approach. Welcome to the next generation of RBP……………………

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ER Doctors & Nurses Face Reduced Income

Wednesday, April 1st, 2020

Emergency room doctors and nurses many of whom are dealing with an onslaught of coronavirus patients and shortages of protective equipment — are now finding out that their compensation is getting cut………………….

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Wednesday, April 1st, 2020

RiskMangers.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.

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Wednesday, April 1st, 2020

Superior Access grants independent agents the ability to work from anywhere…………..

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Please Stop Calling the Chinese Flu For What It Really Is!

Wednesday, April 1st, 2020

CHINESE FLUE – Severe Acute Respiratory Syndrome Coronavirus 2 

“From a risk communications perspective, using the name like Chinese Flu can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia…….”

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PaydHealth Strategies To Tame Specialty Drug Cost

Wednesday, April 1st, 2020

Plan requires members to complete the application process,  in good faith, for alternate funding programs…… …

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Chinese Flu Creates Opportunities for TeleMedicine

Tuesday, March 31st, 2020
Telemedicine utilization will explode due to current state of affairs. I believe as consumers begin to get used to telemedicine they will like the convenience and continue to use it after this crisis is resolved. Smart brokers are seizing this new sales opportunity. How are they selling it? By telephone of course.

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Request For Proposals – Third Party Administrator (TPA)

Monday, March 30th, 2020

PCA is publishing RFP 3-215-19 Third Party Administration and Insurance Services, 125 Cafeteria Plans, and Related Items.

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Guide to Combating Medical Debt

Monday, March 30th, 2020

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Doctor Claims 100% Success Against Chinese Flu

Monday, March 30th, 2020

Dr. Vladimir Zelenko has now treated 699 Chinese Flu patients with 100% success using Hydroxychloroquine Sulfate, Zinc and Z-Pak. Dr. Zelenko claims he saw the symptom of shortness of breath resolved within four to six hours after treatment…………………..

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“Free” Cafeteria Plan Administration

Monday, March 30th, 2020

By Molly Mulebriar

Brokers should be cautious yet most don’t seem to be as evidenced by the prolific offer and acceptance of “free” Cafeteria Plan administration services, especially among Texas public school districts.

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5 Minute Coronavirus Test Announced By Abbott

Saturday, March 28th, 2020
The Abbott ID NOW™ COVID-19 test brings rapid testing to the front lines………

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China Boasts of Coronavirus Lung Transplants

Friday, March 27th, 2020

Organ Donor Faces Medical Review Committee

A majority of China’s organ transplants reportedly come from harvesting those of non-consensual “donors”…………….

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Dentistry, Aerosol and COVID-19

Thursday, March 26th, 2020

By Darrell Pruit, DDS

If my suspicion is correct – that aerosol driven from the mouths of patients by dentists’ high speed handpieces can carry the COVID-19 virus – we could be witnessing an alarming increase in dental office closures due to occupational illnesses in the weeks following Easter Sunday services, or even an official “all clear” signal much later.

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Buyback Deductible

Thursday, March 26th, 2020

“A buyback deductible, also called a deductible buyback, can be an add-on to an existing insurance contract or may be purchased separately.” For example, it can be a method to buy down a high deductible health plan specific to certain specified conditions.

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Former Harlingen Car Salesman Turned Insurance Industry Legend

Thursday, March 26th, 2020

He entered the insurance industry in 1964 when he was lured away from selling cars in Harlingen, TX……

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School District Improves Benefits & Reduces Costs 50%

Tuesday, March 24th, 2020

School district cuts healthcare spending in half while reducing employee cost-sharing by $1,000. More evidence size doesn’t matter, smart risk management does…………….

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Virtual Primary Care – Useful Access To Care in Today’s Pandemic

Monday, March 23rd, 2020

Getting quality care just got a whole lot easier

Forget what you know about traditional primary care: the inconvenient scheduling, long wait times and increasing expenses. 98point6 is pioneering a new approach to primary care, using technology to bring affordable, on-demand access to everyone—because we think that’s the way it should be.

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Healthcare’s Looming Financial Implosion

Saturday, March 21st, 2020

America needs to establish a Hospital System Super Fund immediately of $300 billion-$600 billion……….

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BCBS Seeks To Cultivate Relationships With Brokers Assigned To TRS ActiveCare Accounts?

Saturday, March 21st, 2020

Sun Tzu

Could having a local representative on the ground disguised as a punching bag, gauging and influencing perception and needs among members be the motivation?

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PBM Sends RiskManagers An Unsolicited Kickback

Friday, March 20th, 2020

As a fee based insurance consultancy, you can imagine our surprise when we opened a letter sent to us in February 2020 from a PBM and found an unsolicited commission check made payable to RiskManagers.

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Austin, Texas Company Announces Home Chinese Flu Test

Thursday, March 19th, 2020

The First U.S. Company Has Announced an Upcoming Home COVID-19 Test

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Health Insurance Primer For Idiots

Tuesday, March 17th, 2020

Health Insurance 101

Chapter 1 Correlation Between Provider Reimbursement & Rate Setting

Chapter 1 Takeaway: GREEN IS GOOD, RED IS BAD

By Molly Mulebriar

Provider reimbursement difference between a traditional Managed Care plan (PPO) and a Reference Based Pricing plan is illustrated in the graph above.

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Cost Impact of Chinese Flu

Monday, March 16th, 2020

“Anyone know what the COVID-19 (Chinese Flu) Medicare CPT codes U0001 and U0002 Medicare payment rates are?” – Bill Rusteberg

“Bill, it’s our understanding those are old codes and fees.  They have been updated and there are new fees.  We’re trying to get confirmation, but it looks like Medicare will pay $305 for the test.  We’ve heard hospitals will charge anywhere from $900-$3,000”Physician

“Wow our TPA is already seeing cost of test between $2,000 and $3,600. We did decide to go ahead and cover testing under preventative so it is free for employees with our insuranceHR Director

Our director of health services seem to think the test will run $295″HR Director

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Plan Sponsors Discover Penny Lane

Sunday, March 15th, 2020

By Bill Rusteberg

Why do some plan sponsors settle balance bills for their members when they don’t have to in the first place? And when they do why do they often agree to pay significantly more than warranted in medical debt market rates?

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Chinese Flu Hits Yoakum, Texas

Friday, March 13th, 2020

YOAKUM, Texas- A male patient was seen on March 7th at the Yoakum Community Hospital who presented mild flu like illness, returning a couple days later (specifics of date was not given) with shortness of breath prompted emergency position on call for the patient to be transferred to an Austin facility to be tested for COVID-19 resulting in a positive testing……………..

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Society of Actuaries Research Brief: Impact of Coronavirus COVID-19

Wednesday, March 11th, 2020

“Transmission rates for diseases, and the intensity of an outbreak, are highly dependent on how the pathogen travels between people. Coronaviruses generally can travel up to six feet from an infected person, as they move through respiratory droplets produced through sneezes, coughs or conversations………..”

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Book Release: The Great American Healthcare Scam

Wednesday, March 11th, 2020

Hello again everyone!

My book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States is now available for purchase on Amazon Kindle.

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Don’t Leave Fox Guarding Employer Plan

Tuesday, March 10th, 2020

A cautionary tale where a self-insured employer health plan implemented a reference-based pricing mechanism…………………

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Down But Not Out – Legal Battle Over North Carolina Allegations Continues

Tuesday, March 10th, 2020

Greg Lindberg and his consultant are continuing to fight allegations that they promised to make improper campaign contributions to the re-election campaign for the North Carolina insurance commissioner.

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Hurry, Eliminate Coronavirus for Only $300

Monday, March 9th, 2020

“Let’s say it hasn’t been tested on this strain of the coronavirus, but it’s been tested on other strains of the coronavirus, and it has been able to eliminate it within 12 hours.”

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Texas Company Claims To Have Developed Coronavirus Vaccine

Monday, March 9th, 2020

Texas-based company claims to have developed coronavirus vaccine. The vaccine will first need to be tested on animals, but could be available by the end of the year.

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Liability Needle For RBP Lawsuits

Monday, March 9th, 2020

needle111

By Bill Rusteberg

Reference Based Pricing plans have been around for many years now. Fear of lawsuits by medical caregivers, particularly hospitals, is a concern for middle and late adapters of the model, causing many to pay a premium for protection. The cost to do so can be significant and out of proportion to the risk assumed.

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One Man’s Gain Is Another Man’s Loss

Monday, March 9th, 2020

Cigna and Houston Methodist (New Best Buds) announces a long-term agreement…………..But UHC says Houston Methodist is driving up the cost of health care for the people of Houston………..

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Zero deductibles and $5 copays?

Sunday, March 8th, 2020

Employers are slashing deductibles and copays so more workers will go to primary care doctors — and avoid unnecessary trips to the emergency room………………..

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Doctors Push Back As Congress Takes Aim At Surprise Medical Bills

Sunday, March 8th, 2020

This is a fight between doctors and insurers over rate-setting and reimbursement………….

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TRS ActiveCare Addresses District of Innovation Concerns

Friday, March 6th, 2020

TEACHER RETIREMENT SYSTEM OF TEXAS MEETING BOARD OF TRUSTEES AGENDA February 20, 2020 – 8:00 a.m. February 21, 2020

Receive an update on TRS-ActiveCare district participation, including the potential consequences to TRS-ActiveCare of participating Districts of Innovation (DOI) offering competing health care coverage to their employees and protecting the stability of TRS-ActiveCare – Katrina Daniel

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TRS ActiveCare Dumps Aetna, Embraces BCBS

Friday, March 6th, 2020

Beginning Sept. 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will serve nearly 1,100 TRS-ActiveCare school districts, plus half a million employees and their families across Texas. Hopes are to increase value by building a primary care health delivery based plan. 

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7 Reference Based Pricing Guarantees

Friday, March 6th, 2020

By Molly Mulebriar

Believe it or not, most consumers and plan sponsors don’t know anything about Reference Based Pricing strategies and those that think they do have all kinds of misconceptions.

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Walmart Sees Big Opportunity in Cash Based Medical Services

Thursday, March 5th, 2020

(Walmart) could very easily become a dominant player in cash based medical services very quickly…….

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Insurance = Unequal Distribution of Assets

Wednesday, March 4th, 2020

Insurance schemes benefit fewer than many. An earned benefit is not without a loss so the net benefit is less than the earned benefit. All parties to the scheme suffer losses, whether its an indemnified loss or cost-of-risk loss.

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Paralyzing Pandemic Strikes Texas School Districts

Tuesday, March 3rd, 2020

An unreported pandemic strikes Texas school districts. Austin based doctors recommend the ostrich approach to health care management………………..

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Case Study: Printing Money

Tuesday, March 3rd, 2020

In the fall of 2018, a 300 employee industrial graphics and printing business was referred to our team to help take back control of their health plan. Over the course of the next 12 months, the client realized a reduction in health care spending of over 40%, or about $4,000 per employee per year, without watering down their benefits design. Here’s how…

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City of McAllen, Texas RFP Group Health & Rx Plan

Tuesday, March 3rd, 2020

City of McAllen
03-20-S27-293
EMPLOYEE HEALTH AND PHARMACY PLAN

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AMA: Insurers Misused CPT Codes To Hide Administrative Costs

Thursday, February 27th, 2020

Aetna Inc., Aetna Life Insurance Co. and Optumhealth Care Solutions Inc. allegedly misused CPT codes to pass on administrative charges under the guise of medical care………….

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Sleepy TRS ActiveCare Trustees & Clueless Texas Legislators

Thursday, February 27th, 2020

“Legislative inaction has now led to an insurance program for school district employees that is more burdensome than beneficial, and for many educators, it amounts to a pay cut year after year.”

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Coronavirus Highlights Chinese Drug Dependency

Tuesday, February 25th, 2020

Coronavirus has jeopardized the “domestic supply of some 150 prescription drugs, including antibiotics, generics, and branded drugs…………..”

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The Great American Healthcare Scam

Monday, February 24th, 2020

The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States.

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BCBSMN ASO Agreement

Sunday, February 23rd, 2020
A self-funded plan using BCBSMN as the Plan Administrator pays out-of-network providers 200% of Medicare. What do they pay in-network providers (Hint: it’s more).

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Ruben Edelstein

Thursday, February 20th, 2020

By Bill Rusteberg

Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.

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Survey Reveals “Me Too” Brokers In The Majority

Thursday, February 20th, 2020

“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”

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Turning Bronze Into Gold

Tuesday, February 18th, 2020

Turning Bronze Plans into Gold Plans at Bronze Plan costs is a common but unspoken strategy……………but who is benefiting from “beating the system?”

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China Can Shut Down U.S. Pharmacies & Hospitals in Months

Saturday, February 15th, 2020

“China’s stated aim is to become the pharmacy to the world with its own companies. And what we’re seeing with Western generic drug companies, they’re collapsing because they can’t compete.”

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What’s An Actuary?

Friday, February 14th, 2020

How do we know we are doing much better this year than last year?

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The Payer You Never Heard Of

Thursday, February 13th, 2020

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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Quizzify’s Surprise Medical Bills Solution

Monday, February 10th, 2020

“If a hospital (y) later turns down “two times Medicare (2x) and it goes to court, their lawyer is going to say, ‘We could lose this thing……………………..”

200% of Medicare represents a “savings” over a typical 60% PPO discount?

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TRS ActiveCare Can Be Fixed, But We’re Tired of Waiting

Saturday, February 8th, 2020

Rather than kicking the can down the road to the next legislative session, sleepy TRS ActiveCare trustees should take note and consider adoption of newer, proven risk management strategies as other risk pools have done……………………….

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Everyone Is Paying For Mary’s Deductible Because Mary Isn’t

Friday, February 7th, 2020

Lucky Mary. She has a $1,500 deductible through her employers health plan but everyone else is paying for it because she’s not…………….

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Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club

Friday, February 7th, 2020

Members of the 50% Club subscribe to the Upside Down Economics of Health Care. They understand those who pay on time are screwing themselves and those that don’t are rewarded…………….

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TASB Issues Health Insurance Survey Results For Texas School Districts

Thursday, February 6th, 2020

Hard working Matamoros street vendors may make more than Texas school teachers………………..

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Pricing Customers Out of Health Care

Wednesday, February 5th, 2020

               You Want How Much!

As Out-Of-Pocket Health Costs Rise, Insured Adults Are Seeking Less Primary Care

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Happy New Year! Your Drug Prices Just Went Up!

Friday, January 31st, 2020

“Drug prices are out of control, and Big Pharma continues to raise the prices for all Americans……….Not only does that mean higher prices at the pharmacy counter, it also means higher premiums and other healthcare costs for everyone.”

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Dual Coverage Dilemma

Thursday, January 30th, 2020

After satisfying their initial waiting period averaging 47 years, approximately 30% of the American workforce is eligible for special health care pricing while the remaining 70% aren’t. Paying for it during their entire waiting period, they deserve better pricing………………..

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Austin Independent School District Seeks Insurance Consultant

Wednesday, January 29th, 2020

The RFP is essentially requesting the services of an assortment of experts…………….

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Okahoma To Eliminate PBM Middlemen

Sunday, January 26th, 2020

“It’s time we cut out the middleman and get our citizens the savings they desperately need.”

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Half Pregnant Tulip Lovers vs Cliff Dwellers

Saturday, January 25th, 2020

Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks.

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Washington D.C. Symposium Highlights Private Initiatives in Health Care

Friday, January 24th, 2020

The purpose of this event is to inform employers, brokers, legislators and regulators about emerging initiatives to expand access, improve quality and reduce the cost of health care. – Dan Meylan

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Pandemic?

Friday, January 24th, 2020

The fatality rate may prove to be comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally……………

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Once Deported Illegal Back – Demands $5,000,000 Plus Needed Medical Care

Wednesday, January 22nd, 2020

Texas Detainee demands immediate release, $5,000,000 and medical care…………

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Health Policy Predictions for 2020  

Wednesday, January 22nd, 2020

The private market will offer new funding strategies for employer-sponsored health plans……

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Texas ER Doc’s Gravy Train in Jeopardy

Wednesday, January 22nd, 2020

Emergency room physicians (and their anesthesiologist cousins) are a different breed. They don’t often join managed care networks. They serve a captive audience. The only emergency room door exit is to the billing department. They  charge an arm and a leg. They are the Balance Bill Kings of Health Care because they almost always do and never, almost never, ever, negotiate. But that’s about to change in Texas………………unless your’e insured through an Arm & A Leg Plan (self-insured plan). 

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Self-Funded Employers Driving Health Care Cost Containment

Monday, January 20th, 2020

Under prevalent status quo heath plans, cost containment means higher deductibles, higher out-of-pocket expenses, less choice. All are impediments to health care.

On the other hand, under Reference Based Pricing plans, cost containment means lower deductibles, lower out-of-pocket expenses, more choice. There are less impediments to health care. 

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The WellRithms Shield

Sunday, January 19th, 2020

The Shield is an ERISA-compliant product that deals with high-dollar medical claims and COMPLETELY PROTECTS the member from balance billing abuses with guaranteed savings.

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CIGNA Sued For RICO Violations

Sunday, January 19th, 2020

In summary, the lawsuit alleges that CIGNA accepts the out-of-network provider’s claims at the full billed charges and requests the same amount from the self-insured health plan.

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