“The City’s negligence was a direct cause of the plaintiffs’ damages. The city is liable to the plaintiffs for their damages,” the lawsuit argues.
Continue reading Insurance Company Sues Minneapolis For ‘Negligence’ During George Floyd RiotsCategory: Uncategorized
Government Reports 17% of In-Network Claims Denied
Illegal Aliens Sign Up For Free Obamacare in San Antonio?
Outside the NGO processing center in San Antonio Tx, Illegals that have only been in the United States for less than 48 hours were being signed up for free health insurance.
Continue reading Illegal Aliens Sign Up For Free Obamacare in San Antonio?CrowdHealth Isn’t Health Insurance… and Why That’s a Good Thing!
“Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”Did you know that the United States government limits the amount of profit health insurance plans can receive from your premiums? That sounds great in theory, but think about it this way: if a health plan can only make profits on up to 15% of your premium, and you have a $1000 premium per month, their profits are limited to $150 per month on that price. So then, what’s a major way health plans can grow their profits? By increasing your monthly premiums! If they boost your premium by 10% to $1100, they can now profit $165 per month. This means health plans are now incentivized to make your prices go up, not go down.”
Continue reading CrowdHealth Isn’t Health Insurance… and Why That’s a Good Thing!22 Men and A Cat
INCREDIBLE STORY from the history pages of Lloyds of London
By Paul Miller
A cat features in this, my favourite story from the Lloyd’s archives. I post it every now and then, for those that haven’t heard it as it’s so extraordinary.
Continue reading 22 Men and A CatAdios, Es Hora
By Bill Rusteberg
One of the hardest things a consultant can do is fire a client. Today we did just that. It wasn’t an easy decision. This is a client we’ve served for many years, earning deep friendships within the organization that will endure.
Continue reading Adios, Es HoraTeeny-Weeny PBMs Challenge The Big Boys
Startups promising lower costs and transparency challenge the largest benefit managers………….
Continue reading Teeny-Weeny PBMs Challenge The Big BoysSherlock Holms Of Insurance
By Paul Miller
Sir William Charles Crocker was a man often referred to as the “Sherlock Holmes of Insurance”.
Continue reading Sherlock Holms Of InsuranceI Just Might Be A Psychopath
By Andy Schoonover, CEO CrowdHealth
Here is a story about how I just might be a psychopath (and how I saved 88% on my medical bill in 12 minutes).
Continue reading I Just Might Be A PsychopathLloyds of London
“We now have our cars insured by Lloyd’s of London. I do not anticipate any further insurance problems” – Martin Luther King
RiskManager.us Invests In Latest Technology
RiskManagers.us official demonstrates latest cutting edge technology in front of stunned audience.
Continue reading RiskManager.us Invests In Latest TechnologyThe Best Work Comes Out of Great Relationships
By Bill Rusteberg
As a self employed insurance agent I’ve worked with hundreds of clients over the past 50 years, the result of calling on thousands more in prospecting efforts to gain more business. I’ve met all types of personalities, developing a skill few have. Understanding motivation, goals and interests is secondary to understanding moral and ethical values of those you strive to do business with.
Continue reading The Best Work Comes Out of Great RelationshipsRural-Urban Healthcare Access Gap: It’s All About The Fixed Costs
“Recognizing the key challenge of paying for the fixed costs of rural healthcare practices and facilities, government-induced and -subsidized capacity should focus on meeting what rural residents need the most, such as supporting primary care……….”
Continue reading Rural-Urban Healthcare Access Gap: It’s All About The Fixed CostsAldeen’s Sunday Morning Bathroom Read
By Doug Aldeen
In August of 2023, Advent Health fled a lawsuit alleging that MultiPlan’s business model of contracting with fellow payers and aggressively repricing out-of-network service payments is anticompetitive under Section 1 of the Sherman Act.
Continue reading Aldeen’s Sunday Morning Bathroom ReadWill Government Grant Pardons To Death Row Inmates?
Government has been known to mandate certain life saving vaccines quickly, without years and years of clinical trials hobbled by a burdensome administrative state about as efficient as the U.S. postal service. Cancer patients dealt a death sentence wonder why a vaccine that’s been around for over a decade with a promising cure rate can’t be made widely available right now, before death do they part cancer’s death row.
Continue reading Will Government Grant Pardons To Death Row Inmates?Bernie Sanders Proposes Subpoenas of CEOs of J&J, Merck On Drug Prices
“Considering that drugs like Eliquis have net prices that are a fraction of the list prices – with so many of those rebates going to government programs – if the committee wants answers for why the prices are so high, maybe instead of pharma execs, they should subpoena a mirror” – Antonio Ciaccia
Continue reading Bernie Sanders Proposes Subpoenas of CEOs of J&J, Merck On Drug PricesValueHealth Benefit Administrators
Terri Raimondi – Senior Vice President, Business Development and Marketing
Benefit Administrators is progressive and committed—an authoritative Third Party Administrator known for flexible, innovative solutions and unparalleled customer service.
Continue reading ValueHealth Benefit AdministratorsLose Weight With GLP-1 Medication Prescribed Online & Delivered
Want one of those expensive employer paid weight loss drugs that’s bankrupting health plans without having to go through all the usual hassles of taking time off for work to see a doctor for a prescription? Now you can……………..
Continue reading Lose Weight With GLP-1 Medication Prescribed Online & DeliveredThe Silent Epidemic Eating Away Americans’ Minds
By Marina Zhang
Billy was a bright 10-year-old boy with two Ivy-League-educated parents. He was book smart—got straight A’s in school—but lacked street smarts.
Continue reading The Silent Epidemic Eating Away Americans’ MindsInsurance Coverage Makes Common Generic Drugs More Expensive
“Congress and state legislatures should consider allowing insurance plans not to cover common generic drugs. This move would fundamentally resolve the spread pricing problem created by pharmacy benefit managers, eliminate wasteful spending on these drugs and lower insurance premiums for all.”
Continue reading Insurance Coverage Makes Common Generic Drugs More ExpensiveThe Baby Survived But the Mom Almost Had a Heart Attack When She Got the Hospital Bill
By Marshall Allen
‘That’s an incredible victory! But like many of these wins, it’s bittersweet, because it exposes an outrage. Neither the hospital nor the insurer had been complying with the Illinois law.”
Continue reading The Baby Survived But the Mom Almost Had a Heart Attack When She Got the Hospital BillUS Drug Prices Are 8x the Cost in Peer Countries for Some Drugs
For nine out of ten Medicare-negotiated drug prices, the US still faced higher costs than peer countries even with rebates.
Continue reading US Drug Prices Are 8x the Cost in Peer Countries for Some DrugsMaintaining Access to Rural Healthcare Amid Closures
The cost of delivering quality care is higher than ever, while payers are looking to downsize reimbursement rates as much as possible.
Continue reading Maintaining Access to Rural Healthcare Amid ClosuresThe High Cost Of Weight-loss Drugs Is Threatening Coverage Altogether
By Lucy Peterson
January 16, 2024 at 08:45 AM
With the price of GLP-1s reaching well over $1000 a month, local officials are warning that rising costs threaten to quickly drain government spending accounts.
Continue reading The High Cost Of Weight-loss Drugs Is Threatening Coverage AltogetherAssessing Early Experience With Arbitration Under The No Surprises Act
What is the No Surprises Act? “It’s a law that transfers balance billing liability from plan members to plan sponsors under certain circumstances gifting the balance biller a much better opportunity to recoup from a deep pocketed plan sponsor than from a Joe Sixpak.” Bill Rusteberg
Continue reading Assessing Early Experience With Arbitration Under The No Surprises ActLloyds of London
By Paul Milller, London Market Insurance
In April, 1936, a piece of paper was passed around the Underwriting Room at Lloyd’s of London bearing at the top the notation “Queen Mary — £4,800,000”.
Continue reading Lloyds of LondonThe Most Powerful Natural Pain Killer In The World?
You saw the media frenzy on Fox. – After 11 years of private testing, Conolidine “Nature’s Morphine” is now legal worldwide.
After a 100,000 person clinical analysis Conolidine is now certified as the most powerful natural pain reliever in the world…. Boasting pharmaceutical level relief with no negative effects.
Next Insurance
Unfair Business Tactics
By Bill Rusteberg
Health insurance brokerage is nasty business. It’s a replacement sale reliant upon destroying relationships. For some anything goes, colored under the heading “All Is Fair In War.” The good news is sometimes the good guys win. So how are they able to do that?
Continue reading Unfair Business TacticsOne Drug, Five Prices
Tom, Dick and Harry go to the same drug store to pick up the same drug, through the same PBM, on the same day. Each is asked to pick their price behind doors number 1, 2, 3, 4, or 5. Tom picks Door #1 much to the pharmacist’s displeasure. Dick picks Door #3 as the pharmacist nods approval. Harry picks Door #5 and the pharmacist belts out a joyful YES!
Continue reading One Drug, Five PricesThe Dark History Of A Pharmaceutical Company
Bayer is a German multinational pharmaceutical and biotechnology company and is one of the largest pharmaceutical companies and biomedical companies in the world.
Continue reading The Dark History Of A Pharmaceutical CompanyWholesale Generic Drug Pricing Will Amaze You & Piss Off Your PBM
ScriptCo is a membership-based pharmacy making prescription medications more affordable for everyone.
Continue reading Wholesale Generic Drug Pricing Will Amaze You & Piss Off Your PBMSmart Pharmacy Plan Bypasses Middle Men
SOURCE: Oniline Pharmacy – Employer Solutions | DiRx Health
“In bypassing multiple middlemen in the distribution chain, DiRx is streamlining the path between the manufacturer and the consumer…………………..”
Continue reading Smart Pharmacy Plan Bypasses Middle MenTop Dog Or Underdog? Bargaining Power In Healthcare
By Ge Bai – Contributor|HEALTHCARE
In healthcare and elsewhere, the price of services and products is determined by the relative bargaining power between the buyer and the seller. A top dog can afford to walk away without entering the transaction, whereas an underdog cannot. Being the top dog or the underdog makes all the difference for prices in healthcare.
Continue reading Top Dog Or Underdog? Bargaining Power In HealthcareThe Parable of The River
“One day, a group of villagers was working in the fields by a river. Suddenly someone noticed a baby floating down the river………….”
Continue reading The Parable of The River2024 RiskManagers.us Fee Schedule
“How Much Do You Charge?” is a question that invariably enters the conversation when meeting a prospective client for the first time. So in 2014 we published our fee schedule for all to see and marvel.
Continue reading 2024 RiskManagers.us Fee ScheduleMarpai Hires The Best of The Best
Marpai Hires John Powers as President
MyHealthGuide Source: Marpai (Nasdaq: MRAI), 1/12/2024
NEW YORK — Marpai, Inc., an independent national Third-Party Administration company transforming the $22 billion TPA market supporting self-funded employer health plans, announced the appointment of John Powers as the Company’s President. Powers is an accomplished healthcare benefits executive with over 30 years’ experience. Powers was previously CEO of Homestead Smart Health Plans.
Continue reading Marpai Hires The Best of The BestThe Affordable Care Act Hasn’t Done Squat
Insurance protects one from loss. But how much of the loss is covered?
Continue reading The Affordable Care Act Hasn’t Done SquatHelping People Feel (and look) Better In Deep South Texas
“The Lower Rio Grande Valley, like many other communities in the United States, is facing a diabetes epidemic. The growing health crisis of widespread diabetes threatens individuals, families, the health system, and the prosperity of the Rio Grande Valley community.” SOURCE: Preventing Diabetes in the Rio Grande Valley – FSG
Continue reading Helping People Feel (and look) Better In Deep South TexasTurtles, Birds And Rabbits
Will a full-body MRI scan help you or hurt you? A doctor gets his own scan and finds out…………….
Continue reading Turtles, Birds And RabbitsWhiny College Professor Hates Aetna
A WHINY COLLEGE PROFESSOR POSTED THE FOLLOWING ON LINKEDIN:
“Stanford University moved its health insurance from California Blue Shield to Aetna. It is now January 9, and I have yet to receive a card showing my member number, which is the evidence of coverage virtually every pharmacy and medical provider demands in order to get service.”
Continue reading Whiny College Professor Hates AetnaMarpai Stock Tanks Despite New Management Team
9:30 CST 11 Jan 2024
By Bill Biloselhigh
The market could care less there’s new management in place at Marpai…….
Continue reading Marpai Stock Tanks Despite New Management TeamAmerican Health Care Has A Moral Problem
Early in my journalism career, I wrote about murder, drug deals and domestic violence. That’s wrongdoing our country rightly condemns.
Continue reading American Health Care Has A Moral ProblemMoney Affects Behavior
Back in the day health insurance didn’t finance loan free loss, it reimbursed loss.
Continue reading Money Affects BehaviorICHRAs Designed to Minimize Offloading Bad Experience
Can companies shed bad claims risk by moving to an ICHRA to fund their employees’ medical coverage? Yes. But the law minimizes the opportunity.
Continue reading ICHRAs Designed to Minimize Offloading Bad ExperienceDifferences In The 30 Day Cost of Two Prescription Drugs
“As the call for clearer prescription drug pricing has grown, there could be significant shifts in the prescription drug landscape in the coming years … Concerns have arisen around manufacturers potentially raising costs for non-Medicare plans to recoup lost revenue from IRA price negotiations. … There are several situations that could result in increased or decreased costs for plan sponsors in addition to potential price shifting.”
Continue reading Differences In The 30 Day Cost of Two Prescription DrugsWalgreens Settles “Falsely-Inflated” Drug Prices Lawsuit
Those of us in the health benefits field know Walgreens as one of the most expensive prescription drug retail outlets on the planet. Most of our clients have eliminated Walgreens from their network.
Continue reading Walgreens Settles “Falsely-Inflated” Drug Prices LawsuitFiduciary Liability Insurance
If your company offers health insurance benefits, then you most likely have a department of people that oversees the program. But did you know that if one of them makes a mistake your company could be held liable?
Continue reading Fiduciary Liability InsuranceConservative Momentum Builds to Lower Health Care Costs
The following content is sponsored by Conservatives for Lower Health Care Costs.
Recently, Big Pharma and Big Government have teamed up in a full-blown attack against free market solutions in the prescription drug market by focusing on Pharmacy Benefit Managers (PBMs) – which currently serve as the only real check on big pharmaceutical companies’ ability to set sky-high prices for prescription drugs.
Continue reading Conservative Momentum Builds to Lower Health Care CostsThis Reminds Me Of A West Texas School Superintendent
If you’ve learned a lot about leadership and making a movement, then let’s watch a movement happen, start to finish, in under 3 minutes, and dissect some lessons:
Continue reading This Reminds Me Of A West Texas School SuperintendentThe KISS Method Of Selling
Skimming Money
Nearly half of every dollar spent by Medicare drug plans goes to private health insurers’ pharmacy benefit managers and wholesalers
As members of Congress get back to business after the holidays, they seem to be poised to pass legislation that would address some of the abuses of pharmacy benefit managers (PBMs), the middlemen who extract so much money from the pharmaceutical supply chain.
Continue reading Skimming MoneyThe Ole PBM Switcheroo Strikes Again
CVS Caremark to kick AbbVie’s Humira off some formularies in favor of cheaper biosimilars
By Zoey Becker– This year, CVS Health plans to employ the classic “out with the old, in with the new” mantra when it comes to AbbVie’s Humira.
Continue reading The Ole PBM Switcheroo Strikes Again“CEO’s Waste A Shit Load Of Money On Health Care”
By Molly Gamble – There are many organizations in the United States that hold themselves out as advocacy organizations for better care for patients, but is that what they are really about?
Continue reading “CEO’s Waste A Shit Load Of Money On Health Care”Marpai Stock – 2023 “A Year To Forget”
With 2024 starting with new leadership, most notably with John Powers at the helm, hope springs eternal among patient investors.
Continue reading Marpai Stock – 2023 “A Year To Forget”The Best Salesman In New York
By night, Joe Ades dines with his fourth wife at exclusive restaurants, sips Veuve Clicquot at the Pierre, and goes home to a three-bedroom Park Avenue apartment. By day, he is something else altogether. At 72, the “peeler guy” in the Turnbull & Asser shirts is a New York legend.
Continue reading The Best Salesman In New YorkAldeen’s Sunday Morning Bathroom Read
A Weekly Read By Doug Aldeen
Activist New York Governor, Kathy Hochul, has vowed to protect New Yorkers from medical debt, limit hospitals’ ability to sue patients and expand financial assistance programs as part of her 2024 State of the State.
Continue reading Aldeen’s Sunday Morning Bathroom ReadSnake Killing Consultants vs Animal Rights Consultants
“I come from an environment where if you see a snake, you kill it. At GM, if you see a snake, the first thing you do is hire a snake consultant. Then you get a committee on snakes and discuss it for a couple of years.” – Ross Perot
Continue reading Snake Killing Consultants vs Animal Rights ConsultantsMark Cuban Opines
Cold Calling
Cold calling was scary as hell when I first started as a 22 year old selling cleaner, more efficient homes. After a day’s training, I was taken to a residential street in a nearby city and told “Ok Bill, get out and start knocking on doors.”
Continue reading Cold CallingFederal Bureaucrats Allow Florida To Import Canadian Drugs In Bulk
FDA allows Florida to import prescription drugs in bulk from Canada.
The new policy will allow Florida to buy prescription drugs in bulk. The drugs will be made available through state-run programs such as Medicaid.
Continue reading Federal Bureaucrats Allow Florida To Import Canadian Drugs In BulkOur TPA For This Month Is……
HR. DEPARTMENT: Our TPA is Gilsbar……………… I, I, I mean HealthComp. Opps I meant to say Virgin Plus!………Forgive me, I think I’m losing my mind, I’m so confused!
CEO: But didn’t Hank Say……………………
Continue reading Our TPA For This Month Is……Hospital Accused of Negligence
Family To Sue Over ‘Wrongful Death’ of Eddie Bernice Johnson
Late former Texas congresswoman Eddie Bernice Johnson’s family intends to sue Baylor Scott & White for alleged “medical negligence” that led to her death.
Continue reading Hospital Accused of NegligenceThe Physical & Mental Effects of The Atrocity of War
Pharmacies across the country are dealing with a flood of requests for medical and alternative sleep medications…..In the last three months, close to a hundred thousand distress calls were registered about a feeling of loneliness, depression, anxiety, suicidal thoughts…………
Continue reading The Physical & Mental Effects of The Atrocity of WarLet’s Play Hospital Roulette!
“Our plan pays claims using Medicare as a benchmark plus a 50% bonus. In this instance that totals $1,350 for Joe Sixpak’s one hour emergency room visit” says the emaciated plan sponsor.
Continue reading Let’s Play Hospital Roulette!Yuzu Health – A Different Kind of TPA
Legacy TPA’s are slow to adapt to market changes and even slower investing in the latest technology whereas new, “upstart” TPA’s invest in the latest technology giving them a distinct advantage.
Continue reading Yuzu Health – A Different Kind of TPAMail Order Obesity Drugs
Eli Lilly launches website to get obesity drugs shipped directly to patients via telehealth
Continue reading Mail Order Obesity DrugsAttention Plan Sponsors! – Get Ready To Bend Over
Drugmakers to Hike Prices on 500 Drugs
Big pharma companies including Pfizer are planning to raise prices on more than 500 drugs this month, according to a recent Reuters report.
Continue reading Attention Plan Sponsors! – Get Ready To Bend OverGroup Captive Insurance
Group captive programs are a specialized form of health insurance that allows multiple employers to come together and collectively fund and manage their employee health benefits. It’s a win-win: companies gain more control over their health insurance costs and potentially save money by sharing the risks and rewards of their healthcare program.
Continue reading Group Captive InsuranceFlight Insurance
Watch how Kingfisher, a sales representative for George Stevens Insurance Company, underwrites and sells a Flight Insurance policy in real time………….
Continue reading Flight InsuranceFree Hospital Care In Rural Pecos County
Finding solutions to lower health care costs has never been easier for citizens of Pecos County, Texas. Most qualify for free hospital care provided by the only hospital in the county.
Continue reading Free Hospital Care In Rural Pecos CountyAldeen’s Sunday Morning Bathroom Read
Sunday Morning Bathroom Read (1st Gag Clause Violation of 2024 Edition)
Continue reading Aldeen’s Sunday Morning Bathroom ReadThe Purple Cow PBM
For the Second Time, Capital Rx Makes the Inc. 5000, With Three-Year Revenue Growth of 903% Percent
Continue reading The Purple Cow PBMAmericore Health
“The company quietly loaned $600,000 to James on the condition that his political connections would bring the company funding from the Middle East.”
“Biden told me there’s not a single door in the country that we can’t open. So if I wanted to meet, you know, the head of Google, it’s a phone call” – Grant White, CEO
Continue reading Americore HealthFDA Says Beware of Fake Ozempic
[12/21/2023] FDA continues to investigate counterfeit Ozempic (semaglutide) injection 1 milligram (mg) in the legitimate U.S. drug supply chain and has seized thousands of units of the product.
Continue reading FDA Says Beware of Fake Ozempic