“Although not traditionally classed as self-insurance, program business involves an intermediary assuming many of the roles of an insurance company……….”

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We provide production underwriting services on behalf of Life & Health insurers and managed care organizations for new and renewal business.

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Senate Approves Repeal of Health Insurers’ Antitrust Exemption

By Allison Bell

The repeal bill, H.R. 1418, is now heading to the president’s desk. Read More

Late Monday, both Houses of Congress approved the Consolidated Appropriations Act, 2021 (“CAA”) providing for a sweeping $900 billion rescue package to deliver much-needed relief for small businesses.

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Professional liability, also known as Errors and Omissions Insurance (E&O), protects you if you’re sued for negligently performing services, even if you haven’t made a mistake. Coverage also includes defense costs associated with any lawsuit.

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Health care providers looking to seize opportunities to drive members to their network through their own self-funded products such as hospital owned Community Based Health Plans……………….

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Creates a complex arbitration process between insurers/ self-insured plans and medical providers…………Arbiters are prohibited from taking into account the provider’s “list price” billed charges……………..

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TRS ActiveCare used to be a great deal for teachers, but unfortunately that’s no longer the case. Alternative choices can provide a better solution for Texas teachers and their families.

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Prescription drug costs continue to escalate. Is it better to fully-insure or self-fund the risk?

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“All white people to the back of the bus” screams Harald……………………..

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Hey Doc, how much will you charge, cash, for a Carpal Tunnel Release?. If I like it I’ll pay you in full on the day of service……………………or before if you insist.

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Newest Chinese export benefits corporate coffers worldwide by lowering health care costs for plan sponsors……………….

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The service would bypass health-insurance plans and brokers and could help to lower the cost of healthcare.

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The Gift of Hardship by Tatiana Denning is an excellent short 5 minute read of “Our most important life lessons come when difficulties rain upon us.” 

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An online one-stop shop for small business owners looking for medical coverage for 2 employees up to 300. (more…)

The District (HOSPITAL) argues the insurance cards failed to adequately disclose that the patient’s ELAP plan contracts with MultiPlan only for physician services, not facility services.

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Please wait here in the examing room. Our lab technician will see you in just a few short minutes……

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The company will use the financing to expand its offerings into new markets and further scale its operations in response to growing demand……………..

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In 2013, he made $5 million. Three years earlier, he made $8 million. That’s the kind of money you might expect the CEO of one of the largest hospital chains in the country to earn.

But Ray Ingham isn’t the chief executive of a major health system………………

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TRS ActiveCare will not release claim experience for those districts who wish to offer a competitive commercial health plan alternative. Since experience rating is not possible in these cases, some other way must be employed to underwrite the risk.

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The value in the insurance offering comes from GM and OnStar’s ability to leverage the businesses’ already established ecosystems and improve customers’ insurance experiences. ………….

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Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell | December 10, 2020 at 04:59 PM

The justices held that Arkansas can set payment rules that affect ERISA plans’ pharmacy benefits managers.

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Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell

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Tenet projects the transaction will generate double-digit returns within three years of its completion and 42 percent of Tenet’s adjusted-EBITDA will be generated by USPI’s ambulatory business next year, up from 4 percent in 2014.

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“We strongly believe these losses are covered in full by our insurance policies, and are confident that the court and jury will agree.”

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Increasing litigation, broader definitions of liability, more plaintiff-friendly legal decisions, and larger compensatory jury awards………………….

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Fast & Easy Application for 180+ Professions – Business & Personal Lines

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An employer recently asked if there was any difference in the level of Medicare reimbursements for the two hospitals in their community.

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Doug Aldeen believes commercial insurance plans serve as an ATM for hospitals at the employers and patients expense………..

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Founded in 1986 and headquartered in Boston, Massachusetts, PCG helps primarily public sector health, education, and human services organizations make measurable improvements to their performance and processes.

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The plan offered a guarantee cost for three years – Fixed Cost, Claim Cost and Reserves…………..

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Teachers have historically complained about poor pay and terrible health benefits. Now many of them point to the life threatening environment of the classroom. “I can’t teach in a Death Chamber” is the message to school district officials and taxpayers. So parents remove their children from the public classroom leading to reduced tax revenues for education, continued crappy health benefits and less pay………….

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A September 21, 2011 email reminds us of how much Reference Based Pricing strategies has grown here in Texas. This email (a portion of which is shown below) is from RiskManagers.us to a client……..

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PNOA has mostly Medicare based reimbursements and has achieved aggressive discounts…………

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A recent study of a population with high health care utilization rates found giving individuals access to over-the-counter care benefits can reduce the number of avoidable ER visits and hospital admissions while improving member satisfaction and saving health plans millions of dollars.

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Being out-of-network has never been better! Let’s charge $10,000 for a test that costs $130 and never have to worry about not being paid the full amount………………………..

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AMPS Webinar: New cost containment strategies on the horizon that will enhance the services offered to your clients………………….

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Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.

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AMPS, a rapidly growing healthcare cost containment and risk mitigation company, is expanding its Sales Team. If you are a seasoned sales executive in either the Northeast or Mountain region of the U.S., this is a great opportunity to join a talented team and help achieve our mission of making customers’ healthcare dollars go further.

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In addition to providing a full-service replacement for traditional PBMs, WithMe Health is launching a medication guidance service that complements plan sponsors’ existing PBM infrastructure by personalizing medication selection and member guidance. The service helps employers and health plans curb their costs while optimizing member experience and outcomes.

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“While it’s common to see 20%+ increases in reinsurance this year, both in the last renewal cycle and this one partly driven by leveraged trend, there appear to be fewer new entrants looking to scoop up that business at a loss. So, we have repeatedly found ourselves in situations requiring 30%, 50%, and in some rare cases, even larger increases. Also concerning is the fact that many carriers are curtailing the offer of “no new lasers” contracts.”

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Texas is the only state in the Union where the majority of Texas businesses can elect to non-subscribe. Thanks to our historical fore fathers, this option has been available since 1913.

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When I asked what the total billed charge for the procedure was going to be, that completely flummoxed them………………….

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Beware of Insurance Consultants Dress In Orange…………………

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Former high school coach makes fortune in the insurance industry……………………….

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Texas school superintendent’s $2.25 million buyout threatens district’s finances………………..(Pssst…file this under Poor Risk Managment)

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Rising Health Insurance Rates………..Cost Shifting To Plan Members……………Less Choice

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GROUP HEALTH, DENTAL & EMPLOYEE BENEFITS INSURANCE CONSULTING SERVICES

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CalPERS approved steep rate hikes for its cheapest health insurance plans Tuesday in an effort to save its most expensive plans from collapse…………….price hikes of up to 51% for health plans favored by young, healthy workers

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  Retail Pharmacist Reacts To The News

“Members could save up to 80 percent on generics and 40 percent on brand-name medications when paying without insurance, according to Amazon.”

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Is your school district considering offering self-funded health plans to your employees? This document outlines things to consider when making this decision.”

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The upcoming Texas legislative biennial session is fast approaching and lawmakers will have to address an historic $4.6 billion budget shortfall. “Tell all departments to be prepared to cut their budgets another 5%”  dominates the Austin rumor mill these days. 

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An innovative and disruptive model designed to turn the industry on its head……….model has been shown to reduce health costs for their members by up to 40%…………members can customize the coverage to their individual needs…………..3 year rate guarantee in certain states…………Insured by

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Individual coverage health reimbursement arrangements (ICHRAs), a new employer-sponsored health care benefit program for active employees that became available this year, are drawing the attention of U.S. employers, particularly wholesale and retail employers and those in education and the public sector.

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He saved the ACA in 2012 by declaring the individual mandate essential to the survival of Act and then may save the ACA again in 2020 by declaring that the individual mandate is not essential to the survival of the Act……………………….

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City terminates UHC and enters into direct contract with local hospital system for significant savings…..

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TRADITIONAL REFERENCE BASED PRICING VENDOR REACTS TO NEWS

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

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Premiums can be 20% to 25% less for level funded plans than comparable community-rated plans………….An employer’s savings depend on the health of its employees and their families because an LFP plan is underwritten only for the specific employer’s employee population and not for a broader community.

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MyHealthGuide Source: GuideWell Mutual Holding Corporation via PRNewswire, 11/6/2020

JACKSONVILLE, FL — GuideWell Mutual Holding Corporation (GuideWell), the parent to a family of forward-thinking companies focused on transforming health care, announced that they have signed a definitive agreement to acquire WebTPA, an innovative and market leading administrator of self-funded employer health plans.

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SOURCE: Excerpt from Dave Chase ( Chapter 1: The Future of Health Will Be Local, Open and Independent – Relocalizing Health)

Bryan Perry, and direct primary care veteran, Clint Flanagan, have teamed up to serve employers such as the Bennett School District to reduce spending by ~50% while improving benefits.

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We hope you are keeping well, and keeping your distance. Please join us for a virtual chapter meeting… Wednesday, November 11 11:30am-1:00pm The Zoom invitation is below. You can open this invitation in a browser window, or directly from the Zoom app on your computer or device. We will discuss updates on meetings and general information about the free market. We are graciously requesting each member invite at least one person, either a Provider or Purchaser you think would benefit from FMMA membership. Examples would be: employer you know, especially self-insured interested provider broker/consultant local govt HR purchaser or even politician/policy maker It is mutually beneficial for all of us to share in growing the chapter and the movement. We look forward to seeing you … Thank you.

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