
Your employer is covering 100% of your health plan — no premiums for you!
Continue reading Your New Health Plan – Simplified, Transparent, PowerfulYour employer is covering 100% of your health plan — no premiums for you!
Continue reading Your New Health Plan – Simplified, Transparent, PowerfulLa Feria Independent School District is seeking a qualified Third-Party Administrator to administer its IRC Section 125 plan, benefits enrollment, and optional insurance program and 403 B compliance.
Continue reading Texas School District Seeks Cafeteria Plan AdministratorBy Bill Rusteberg
The American health care delivery system has reached a boiling point. The average working American can no longer afford health insurance and those who can often find they can’t afford to use it.
Continue reading The American Health Care Crisis – Is It Time For Civil Disobedience?Mike Reagan, who has to be as old as I am (We both worked at the same BUCA 50 years ago), has found a living as a drug pusher.
Continue reading Mike Reagan’s Drug CompanyWatch Tonya H. win $10,000 for nailing a 94-foot putt on a basketball court during the Gatorade Golf Challenge at Bishop Ryan School.
Continue reading Tonya Wins Big!Why Use A PBM When You Can Do This Instead?
“We have no choice, it’s a moral issue” announced the company president during an Open Enrollment meeting. “We are not going to garnish your wages anymore for things you can’t afford!”
Continue reading Group Plan Drops PBM With Amazing Results“Don’t worry, nothing is going to change!” said the company owner. “We are merging with another company who has the resources we need to do the things we’ve wanted to do but lacked the resources to do on our own.”
Continue reading What Happens When Two Companies Merge and Then Scale Too Fast?This book is about employer health plans and everyone who swims in that pond. It is a rare and valuable resource to help employers, advisors, direct primary care practices, direct specialty care practices, hospitals, networks and many others thrive in the model of free market healthcare.
Continue reading Don’t Feed The BeastBy Bill Rusteberg
TPAs and carriers find working with health insurance brokers a necessary evil although they will never say so out loud. To do so would be business suicide.
Continue reading The Love-Hate Broker RelationshipMedSave Management LLC is pleased to announce a new partnership with Dollar For to crush medical bills. This public service is completely free–no strings attached.
Continue reading MedSave Management Partners With Dollar For‘Attention Employers, Give Me Your Poor, Your Tired, Your Huddled Employee Masses………….”
Continue reading Free Hospital Financial Assistance ServiceBy Bill Rusteberg
According to Atul Gawande McAllen, Texas is one of the most expensive health-care markets in the country. But it doesn’t have to be.
Continue reading The Amazing World Of Artificial Intelligence Is Alive & Well In McAllen, TexasI once asked a County Judge (who happened to be an attorney) during a Commissioners Court meeting; “Judge, did you read the contract before signing it?”
Continue reading Guess What? Most Plan Sponsors Don’t Read Their ContractsA Six Minute Video Worth Watching……………….Growing evidence you don’t need a PBM to save money. It’s all about sourcing – some sources are better than others.
Continue reading How Mark Cuban’s Cost Plus Drugs Saved Us $490,000Following in the footsteps of similar lawsuits against Johnson & Johnson and Wells Fargo, employees of JPMorgan Chase filed an ERISA class action suit on March 13, 2025. The lawsuit alleges that JPMorgan, as the sponsor and administrator of its self-funded employee health benefit plan, breached its fiduciary duty by allowing CVS Caremark to manage the pharmacy benefits in a manner that enriched CVS Health and its subsidiaries at the expense of Plan members.
Continue reading Plan Sponsor Alert: JPMorgan Chase Faces ERISA Class Action Lawsuit Over CVS Caremark’s PBM PracticesThis morning, I hauled my aging tractor, of a brand no one has ever heard of, forty miles away down country roads no one ever uses to a town no one reading this blog has ever been to.
Continue reading What’s Your Budget?“We care about our valued employees. They are like family. We give them the best health insurance too. We have Blue Cross!” says the Human Resources Director.
Continue reading The BIG LIERisk Managers Purchasing Cooperative offers Participating Employers membership in a proprietary stop loss insurance risk pool designed to better manage their Benefit Programs’ stop loss risk.
Continue reading Risk Managers Purchasing CooperativeAlways good to know what’s out there in the market……………….
Here’s a plug for Curative Life Insurance Company. This Austin, Texas based insurance company is on a Blitzkreig across Texas, writing new business faster than a melting raspa in deep South Texas on an August afternoon.
Their no deductible, no copay, no out-of-pocket financial responsibility is hard to turn down, especially when rates are market competitive. Potential 2 year rate guarantees for groups that qualify.
Continue reading Staying On Top Of The Market“We have the best discounts! We will save you a lot of money! And you can’t do it without us because we have the buying power, you don’t! We are gonna gift you a 50% discount!” says the insurance company.
Continue reading The Great PPO DeceptionBy Bill Rusteberg
The Lower Rio Grande Valley in deep South Texas is known throughout the insurance community as a place where business can take one down the wrong road, purposely or not.
Continue reading Insurance Corruption In Deep South TexasBy Dutch Rojas
Welcome to the Nonprofit Industrial Complex
Continue reading The Non-Profit Industrial ComplexBCBS of MA announces today, they will no longer cover GLP1″s for weight loss beginning on plan anniversary dates in 2026.
Continue reading Blue Cross Blue Shield Dice “NO MAS!”GLP-1 medications pose such a great financial burden to employers that they may agree to a single-payer healthcare system run by the Government as a way of addressing the problem.
Continue reading Financial Impact of Qzempic & WegovyFriday, April 18, 2025 – SOURCE: www.justice.gov
For Immediate Release
Office of Public Affairs
A Florida executive pleaded guilty today for his role in a scheme to submit fraudulent applications to enroll consumers in Affordable Care Act insurance plans (ACA plans) that were fully subsidized by the government. The purpose of the scheme was to obtain millions of dollars in commission payments from the insurance company that operated the ACA plans. The federal government paid at least $133,900,000 in subsidies for fraudulently enrolled individuals.
Continue reading Executive Vice President of Insurance Brokerage Pleads Guilty in $133M Affordable Care Act Fraud Scheme“David” Nourian was sentenced to 17½ years in federal prison—and ordered to forfeit $405 million. His crime? Running a kickback-fueled scheme that paid doctors millions to prescribe $15 compound creams billed at up to $16,000 per tube, mixed in the backroom by teenagers.
Continue reading The Largest Health Care Fraud Forfeiture In DOJ HistoryBy: Marty Schladen – April 17, 2025
Pharmacy middlemen working in Ohio on behalf of huge health conglomerates have long claimed they keep down drug costs. But a report released last week calls that into question.
Continue reading Ohio Medicaid Got Rid Of Big Middlemen, Paid Pharmacies More And Saved $140 Million, Report SaysYou never know what a new hire will end up costing. Take the case of a new hire who started work June 1 of last year. She was on a $500,000 a year drug but the employer didn’t know it.
Continue reading Prescription Drug For Incurable Disease Lasting A Lifetime Costs $47,125 Per YearBy Molly Mulebriar
A Texas school district is sitting on a financial time bomb and their self-funded health plan may provide the spark.
Continue reading Texas School District Sits On A Ticking Time Bomb – The Spark May Be Their Health Insurance PlanErin L. Albert, MBA, PharmD, JD, DASPL
Here’s a list of PBMs we work with at Mark Cuban Cost Plus Drug Company, PBC.
Continue reading CostPlus Drug Company PartnershipsBy Dutch Rojas
The American Hospital Association doesn’t represent hospitals. It represents the right of health systems to keep their billing secrets, crush transparency, and sue your grandma without answering questions.
Continue reading Another Rojas Truth BombBy Bill Rusteberg
Recently I was referred to a large medical group that was interested in learning more about how we help plan sponsors manage their employee health care needs. They were fully-insured with a BUCA and tired of double-digit rate increases year after year.
Continue reading You Don’t Want Me To Know Your Business Because It Won’t Be Good For You!“What are the chances your broker will recommend renewal of your Blue Cross plan this year?” we asked.
Continue reading BLUE CROSS TX Blue Ribbon For Producers Program“At Sentia, our solution is to automate the entire health insurance process. We provide the Electronic Medical Records System (EMR) to practices, price the procedures 10% ABOVE medical consumer price index, and pay for work performed in real time. This eliminates medical coding, insurance networks, adjudication, rate negotiation, the cost of a third party EMR, all the big insurance buildings in every city in the US, and the millions of people that work at the insurance company that you, as the insured, pay for.”
Continue reading Half of Your Health Insurance Premium is Wasted and How to Get It Back“Why is the health of our entire country based on providers who don’t know their own fucking costs?” – Mark Cuban
Continue reading Mark Cuban Says Health Insurance Shouldn’t Exist“If your spouse has access to coverage somewhere else, how would you like us to make that coverage into a 100% Health Plan with no out-of-pocket financial responsibility whatsoever?” purrs the nice HR lady. “We can make that happen if you agree to drop her off our plan!”
Continue reading GREAT NEWS For Employees With Spousal Coverage!“The WHO’s response to the COVID-19 pandemic was an abject failure because it caved to pressure from the Chinese Communist Party and placed China’s political interests ahead of its international duties.”
Continue reading The True Version Of The Origin Of The Chinese FluBy Josh Butler
Recently watched a City Council meeting from a city in the DFW metroplex. The presentation I watched was from a large brokerage firm who handles that City’s benefits. They were discussing the City’s annual renewal.
Continue reading It’s Elementary My Dear WatsonPrescription Care Management Announces Latest Webinar April 23
MyHealthGuide Source: Prescription Care Management, 4/7/2025
RENO — PCM invites brokers, consultants, TPAs, health plans, and plan sponsors to join us for a timely and informative webinar addressing health plan fiduciary concerns. Presenters Chris Metcalf and Garret D’Antoni will guide webinar attendees through the complexities of fiduciary duties in pharmacy benefit management with practical, actionable insights.
Continue reading Fiduciary Duties In Pharmacy Benefit ManagementImagine holding, in your very own hands, a smart phone that can show you “actual” prices for any procedure at any hospital across the Fruited Plains. Imagine further that you can select any hospital of your choice, click a button and discover how much your health plan will pay and how much you will pay, if any.
Continue reading Transparency Revolution: Executive Order Demands Actual Prices, not Estimates“In January 1922, Leonard Thompson, a 14-year-old boy dying from diabetes in a Toronto hospital, became the first person to receive an injection of insulin. Within 24 hours, Leonard’s dangerously high blood glucose levels dropped to near-normal levels.”
Continue reading Why Is Leonard Thompson’s 104 Year Old Miracle Drug So Expensive Today?“ICHRA Won’t Work For Us…..Our Employees Can’t Afford To Pay ICHRA Premiums Upfront!” We hear this a lot from employers who explore ICHRA as an alternative to their traditional group health plan.
Continue reading ICHRA Won’t Work For Us…..Our Employees Can’t Afford To Pay ICHRA Premiums Upfront!Get personalized quotes in 5 minutes
Insurance is complicated, but it doesn’t have to be. While we’re famous for our online comparison tool, we also have a team of 100+ licensed agents dedicated to making insurance shopping simple and stress-free. With a mix of cutting-edge tech and expert know-how, we craft you comprehensive insurance solutions perfectly tailored to your unique needs, with no pressure to buy—just honest advice to help you find the best coverage at the best price.
Continue reading Welcome to The Zebra Insurance AgencyThe following contract language is not uncommon in insurance brokerage agreements:
Term and Termination. The Agreement will continue in effect until the earliest to occur of the following (1) either Party gives at least 30 days notice to the other Party of termination of the Agreement for convenience (which may be for any reason or no reason at all)…..
Continue reading Insurance Agent Contract Termination Language“President Donald Trump said Tuesday that pharmaceutical imports will soon be hit with “major” tariffs as part of his efforts to drive manufacturing back to the U.S.”
Continue reading Trump Says ‘Major’ Pharmaceutical Tariffs On The Way“We’re making more money now that they’ve terminated!” said the TPA owner. “Our runoff admin fees are triple and our PPO access fee changed to a percentage of the savings!”
Continue reading Have You Reviewed Your Termination Penalties Lately?By 2028, 24% of employer-provided plans are expected to be ICHRAs.
Continue reading ICHRA BlitzkriegBy Dutch Rojas
In every empire, there is a hidden court. A ruling elite whose power is felt but rarely seen.
Continue reading The Five Families of HealthcareYou don’t need a PBM to find the best pricing. That’s not their model. You need something better. A better method to find the right price from a reliable source for every drug out there.
Continue reading Lowest Cost Drugs Is All About Sourcing, Nothing More, Nothing LessYou can sell dental and vision coverage to clients of all ages. We offer diverse dental and vision coverage to meet the budget and health needs of your single and family clients. With online enrollment and rates based on location instead of age, they are sure to find the perfect fit.
Continue reading Dental and Vision for Individuals“ For the first time in 40 years, I don’t have to worry about plan renewals, costs, outliers, stop loss, PBM’s and all the other crap……”
Continue reading Group Health Insurance Isn’t What It Used To Be“I’d like my meds without the side effect of bankruptcy, please!”
Pharmacy Benefit Managers (PBMs) have faced criticism for practices that prioritize profits over the needs of patients, pharmacies, and payers.
Continue reading What did the Patient say to the PBM?Incorporated in 1971, Community Action Corporation of South Texas (CACOST) is a private 501 c (3) nonprofit with 53 years of progressive and uninterrupted experience providing high quality services to South Texans.
Continue reading South Texas FQHC – Providing Health Services Since 1971“It’s about as ugly as it can get” says a risk manager. “We don’t send people there anymore, their pricing is outrageous!”
Continue reading What Does A Direct Employer Contract With M.D. Anderson Look Like?Question: Where did the Chinese Flu come from? Answer (A) No Such Thing, it’s a trick question (B) Basement at the White House (C) Chuck Schumer’s boyfriend’s Kitchen (D) Sacramento Water Supply (E) 4th grade experiment at Lincoln Elementary
Continue reading It Didn’t! Yes it did! No It Didn’t. Yes It Did…………According to…………It Did! According to ………..It Didn’t“I don’t think the amount you save on tax free healthcare is greater than not overpaying on unit cost. Benefit advisors need to be doing this math to measure if an employer managing healthcare cost is even worth it.” Leon Wisniewski
Continue reading Is Employer Managed Health Care Even Worth It?Texas lawmakers introduced legislation in March that aims to offer tax relief to small businesses that provide ICHRAs to their employees. Small businesses with between one and 50 employees would qualify for a refund of sales and use taxes or a tax credit against the franchise tax if they adopt an ICHRA and contribute a minimum of $400 per covered employee annually. The refund or credit amount would be calculated based on the number of employees enrolled in the ICHRA during the taxable year, with the credit capped at $400 per employee or the total amount of taxes paid under the sales and use tax system, whichever is less.
Continue reading Texas Lawmakers Consider ICHRA Tax Relief For Small BusinessesBy Bill Rusteberg
Health insurance companies rely on independent insurance agents, brokers and consultants for market distribution. They compete for broker business by contractually capturing their loyalty through bribery and Contracts of Adhesion.
Continue reading Bribery & Contracts of AdhesionHospital Patients are Like Casino ‘High-Roller Whales’ – Hospital / Insurance Negotiation Explained.
Continue reading The Famous Hospital Gotcha ClauseBy Katia Riddle – April 7, 2025
New research suggests that given the right kind of training, AI bots can deliver mental health therapy with as much efficacy as — or more than — human clinicians.
Continue reading The (artificial intelligence) Therapist Can See You NowBROWNSVILLE, TEXAS
The Army, Navy, Marines, and Airforce recruiters stationed in Brownsville, Texas are rumored to be packing their bags and heading out-of-state to greener pastures bringing panic to area residents.
Continue reading Army, Navy, Marines, & Airforce Recruiters Flee Brownsville, TexasBy Bill Rusteberg
The chart shown above illustrates the New Age of health care financing. The traditional role of the TPA is quickly becoming more of a fading memory than a value add.
Continue reading New Era Health Plan Makes SenseBy TOM MURPHYUpdated 6:43 PM CDT, April 4, 2025Share
SOURCE: AP News
President Donald Trump’s administration has decided not to cover expensive, high-demand obesity treatments under the federal government’s Medicare program.
Continue reading Trump Administration Nixes Plan To Cover Anti-obesity Drugs Through Medicare“Brokers are supposed to place the role of trusted advisor, offering expertise in making benefits and healthcare decisions, but …………”
Continue reading Mark Cuban: CEOs Should Create A New C-Suite Role“I’ve spent the better part of three decades dissecting the American health insurance racket from every angle — as an attorney, as strategist, and as someone paid to clean up the mess insurers leave behind. I’ve seen it all.” – Craig Gottwals
Continue reading Confessions from the Belly of the Beast“Traditional TPA centered health plans, inefficient and expensive, are becoming outdated faster than a you can say ‘What Happened?’
“Payer platforms are emerging………….such as the partnership between Mishe Health and Mark Cuban’s Cost Plus Wellness, which allows real-time adjudication, flexible benefit design, same-day provider payments, and transparent contract management.”
Continue reading Employer-Provider Direct Contracting: Practice And Policy“Forget the discount, forget the billed charge, we gonna pay you what we know you’ve accepted in the past. And we ain’t gonna pay no more stinking PPO access fees either!” – Molly Mulebriar
Continue reading TALON’s Universally Acceptable Payment Amount ™By Craig Gottwals
“This is why telling employers they don’t need the legal muscle and case law precedent of Reference-Based Pricing (RBP) is like saying we can ditch the Highway Patrol — because hey, speed limits are posted now!”
Continue reading We Don’t Need The Highway Patrol Anymore Because Speed Limits Are PostedBy Dutch Rojas
After we sold Sano Surgery in the fall of 2022, I spoke with more than two hundred independent practices, including orthopedic groups, surgical centers, and a few physician-owned hospitals.
Each one had its own rhythm, with different EMRs, benefit plans, and ways of operating.
But they all had one thing in common: not a single one was working with other practices to coordinate their property and casualty insurance.
Continue reading Offshore Rx Importation Exempt From Trump Tariffs
ScriptSourcing is pleased to share that pharmaceuticals and personal importation are exempt from tariffs. This decision allows us to continue supporting our clients in reducing prescription drug costs, which is crucial for improving healthcare accessibility. The exemption ensures that plan members can access essential maintenance medications with a $0 copay, significantly enhancing affordability and health outcomes.
Sincerely,
The ScriptSourcing Team
A True Story
“I want to go to MD Anderson!” says Mary. “But they won’t take our insurance!”
Continue reading I Want To Go To MD Anderson!Lawsuit Stuns HR Director – “What! We Have No fiduciary liability insurance!”
April 2, 2025 – BY Nikki Chambers – SOURCE: Nava Benefits
Summary
With rising regulatory scrutiny and an increase in class action lawsuits, fiduciary responsibilities in health benefits are more important than ever. This blog breaks down key fiduciary duties, common missteps, and practical steps HR leaders can take to protect their organizations and ensure compliance.
Continue reading The Fiduciary Survival Guide For HR and Health Benefits
By Bill Rusteberg
How many plan sponsons read their PBM contracts? Or their BUCA ASO contracts? Or any of their health plan contracts?
Continue reading How To Get Fired By Asking The Right Questions (and get free food at the same time)“The 1955 is a Point of Service Cash Pay Health Plan with a RBP wrap. No managed care network, no insurance company, no PBM, just a whole lot of common sense” – Don Pedro
“It’s just 1955,” Cuban said. “You see the doctor, pay them and that’s it. No fuss, no muss.” By paying Medicare rates or lower, Cuban’s contracts save money while ensuring transparency. All agreements are published, encouraging other businesses to adopt similar practices.
Continue reading Mark Cuban’s Health Plan Model