Happy Birthday!

July 28th, 2021

Legislation Introduced to Fix Health Insurance ‘Birthday Rule’

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Scott v. UnitedHealth Group, Inc (Cross-Plan Offsetting)

July 28th, 2021

“When United and a provider dispute whether a claim was overpaid, cross-plan offsetting allows United to act as judge, jury, and executioner.”

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Ruben Edelstein

July 27th, 2021

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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Willis Earns $1 Billion Termination Fee

July 26th, 2021

AON Representative Reacts To The News

Aon will pay the $1 billion termination fee to Willis Towers Watson…………..

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Dr. Hodad, M.D.

July 23rd, 2021

“Somewhere in the world, there is the world’s worst doctor, and someone has an appointment with them tomorrow” – George Carlin

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TRS ActiveCare Under Massive Attack

July 22nd, 2021

Will TRS ActiveCare survive massive assaults by hordes of commercial invaders who believe victory is a given? Battle plans incorporate common sense, reason and logic geared to winning in time for the TRS ActiveCare Armistice Day deadline set for December 2021…..

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Not All Patients Are Treated Equally……Or Are They?

July 21st, 2021

a close up of text on a white background

Unfortunately health plans traditionally do not discriminate by choice of in-network provider because members pay the same no matter who they visit for health care.

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Swiss Re Group & Medical Summit

July 20th, 2021

We are thrilled to invite you to our Group & Medical Client Summit on September 13 – 14, 2021.

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USBenefits Insurance Services, LLC

July 20th, 2021

USBenefits Insurance Services, LLC is a full service Managing General Underwriter, providing Medical Stop-Loss Reinsurance for employer groups through qualified Third Party Administrators and select brokers.

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Phone Call Recordings May Be Requested by Claimants

July 19th, 2021

Phone Call Recordings may be Requested by Claimants if They’re Deemed Relevant to a Benefits Claim

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Private Equity Is Ruining American Healthcare

July 19th, 2021

The rise of PE in medicine has resulted in a proxy war against insurance companies exclusively for the benefit of clandestine shareholders and investment fund managers rather than patients or clinicians………………..

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July 18th, 2021

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Attention Stop Loss Carriers

July 16th, 2021

John Powers Rocks On…………..

July 16th, 2021

Powers is an expert on reference-based pricing (RBP), having worked on RBP plans for over a decade……………..

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The Taste of Success In A World of Failure Is Addictive

July 16th, 2021

Those that don’t play by the rules get the same benefits they have always had but wish they didn’t because they want something better and cheaper………….

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2021 Milliman Study

July 16th, 2021

HOLY COW!

Interesting Milliman study on health care costs. A lot has changed since 1973………..

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The Power of “Skin In The Game”

July 15th, 2021

If this patient didn’t have “Skin In The Game” he would not have shopped for care.

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Camp Coverage In A Five Minute Phone Call

July 14th, 2021

Camp Coverage in a 5 minute phone call – 1-800-334-5579

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DPC + CPO = Better Benefits, Lower Costs

July 14th, 2021

As insurance costs continue to soar you will see a rapid growth in strategies like this among the ever shrinking community of independent PCP’s who remain adverse to the shackles of managed care contracts and hospital ownership of their practice………

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How Montana Is Revolutionizing Healthcare—With Markets

July 13th, 2021

Increasingly fed up with red tape, paperwork and meddlesome third-party rules—especially since passage of Obamacare—a growing number of physicians are opting to bypass both government and insurance companies.

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D.W. Van Dyke Announces Completion and Distribution of its Medical Stop Loss Industry Target Loss Ratio Survey 

July 13th, 2021

Survey results for the January 2020 business indicate a continuation in the favorable loss ratio trend with more than half of all participants achieving or exceeding their respective target loss ratios.

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Texas Eliminates Life & Health Counselors License

July 12th, 2021

Fee based insurance consultants in Texas have been required to hold a Life & Health Counselors License issued by the Texas Department of Insurance. Now anyone who claims to be a fee based consultant and holds a General Lines insurance license may provide insurance consulting services.

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Insurance Consultants Make Pitch To ECISD

July 12th, 2021

The Edinburg Independent School District held public job interviews for insurance consultant and five showed up to make their pitch.

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Cool Hand Luke Starring Tommy Taylor

July 11th, 2021

ATTENTION INSURANCE CONSULTANTS: If you have two hours of free time and want to watch one of the best insurance consultants in our industry deal with a passive aggressive school board this is it.

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Where Did Our $19,000,000 Go?

July 11th, 2021

“Who, me? I don’t have it!”

Edinburg ISD’s self-funded health plan lost $19,000,000 in 18 months and they want to know where it went.

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Requesting Fee Increase With Insurance Companies

July 10th, 2021

It’s on us as practitioners who take insurance to be assertive and request fair reimbursement rates……………….

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Aflac: How To Become An Insurance Agent In Texas

July 9th, 2021

By Bill Rusteberg

In March 22, 1982 I quit my job with a major insurance company to strike out on my own as an independent  commissioned insurance agent. By late July I was nearly broke and worried.

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Ada Betty Finley

July 9th, 2021

The day after college graduation, Ada Betty took the exam to obtain her Recording Agent’s Insurance License. She passed the exam and became the youngest licensed recording agent in the state of Texas, at the age of 20. Her father, J.C. Dunn, founded the American International Life Insurance Company in Harlingen in 1952 and Ada Betty served as Vice President upon obtaining her license.

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Gun Insurance Mandate

July 8th, 2021

California city requires all gun owners to maintain gun insurance……..Meanwhile back at the ranch, Texas enacts Constitutional Carry effective September 2020……….

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Pyongyang General Hospital Demonstrates “Love For The People”

July 7th, 2021

Kim was furious when he received reports  that officials tried to import Chinese, not European, medical equipment. Those involved in the import of this equipment were reportedly executed……….

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Vori Health

July 7th, 2021

Vori Health Raises Additional Capital from Strategic Partners Intermountain Healthcare, Ascension Ventures, and Echo Health Ventures

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Pssst….Want To Make $3.2 Million Next Year?

July 7th, 2021

Godfather, The Cat’s Out of The Bag!

An aggressive insurance agent with relationships with school districts can make a lot of money by taking advantage of the Small Group definition by forming a cooperative for school districts as an alternative to TRS ActiveCare.

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Insurance Brokerages Targeted For Extortion

July 6th, 2021
Ransom monies are probably going to Russia to pay for Ferraris in Moscow…………………….

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Texas Insurance Company In Receivership

July 5th, 2021

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Health Insurance Is Not Really Insurance Anymore

July 5th, 2021

By Molly Mulebriar

Health insurance in the United States is no longer insurance in the traditional sense. It’s become an entitlement welfare scheme that’s fast becoming a heavily regulated government utility.

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Why Insure Expected Risk?

July 5th, 2021

If we don’t buy FAN BELT insurance then why do we buy insurance for routine doctor office visits? A routine office visit costs around $75 – $150 depending on who you see and the type of visit. Insuring a $75 benefit doesn’t make sense and ends up costing more.

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How To Give Employees A Raise Without Giving One

July 3rd, 2021

The erosion of the American middle class continues due directly to the medical-industrial complex. It’s time to stop that by giving working Americans better health care that costs less…….

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Underwriting Risk Is Based On Data

July 3rd, 2021

“He who has data wins. He who has good data wins a lot. He who has real time data wins all the time” – Bill Rusteberg

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MEMORANDUM TO RBP PLAN MEMBERS

July 2nd, 2021

TO:             Reference Based Pricing plan members

FROM:       Human Resources Department

SUBJECT:  How to Avoid Egregious Hospital Balance Billing Practices

Some plan members have experienced threatening creditors clamoring for more money than our plan allowed and paid medical caregivers. As a reminder, our plan pays more than what Medicare pays. Almost all medical providers in the United States accept Medicare payment without balance billing their patients for any more money.

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Upcoding is Not Uncommon – But These Guys Got Caught

July 2nd, 2021

Why get paid less when all you have to do is change a few numbers on a claim form and you’d be driving a cadillac by Xmas……………

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Quizzify Earns Total Victory In Surprise Bill Dispute

July 1st, 2021

Imagine having a surprise bill reduced 95.3%, from $14,269.30 to $674. And that’s without going to court, without conceding a nickel from your initial offer, without trying to qualify for an oxymoronic “financial assistance program,” without hiring an attorney, and even without agreeing to an NDA. (We’ll name the hospital on request. To name it here seems like piling on, and we’re gloating enough as it is.)

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Sandra Can’t Be Happy

June 30th, 2021

Sandra Fluke Reacts To Outrageous Viagra Price Hike

“Outrageous. I fought for free birth control and now this! Our men are entitled to free viagra!

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Walmart Launches Low-priced Insulin

June 30th, 2021

For years, patients, consumer advocates and U.S. lawmakers have complained about the high list prices for insulin and the significant out-of-pocket costs borne by patients.

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The Slow Death of Private Practices

June 30th, 2021

The days when a doctor could show up in a small town, rent an office and hang out a shingle, sadly, is pretty much over. The knowledge base necessary to run a small business is not part of medical education, and few new graduates want to tackle such a task.

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State Auditor McGuiness Demands $24.5M in Overcharges Back From State Employees’ PBM, Express Scripts

June 28th, 2021

PBM Swamp Creature Stunned By Demand

Delaware paid three times the average drug inflationary price between 2018 and 2020 for state employee prescriptions………………

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Water Street 2020 Annual Review

June 28th, 2021

Over the past four years, we have built a leading group of employer health services companies healthcare costs while providing a seamless, positive experience to employees.

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June 28th, 2021

If you have clients with 1.) An annual insurance spend greater than $1,000,000 2.) A good loss history, I have a program that will save them 25%-50% on premiums while not cutting your commission.

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Sonja, You’ve Been Smoking Some Bad Weed!

June 28th, 2021

In one of his first acts as president, Joe Biden directed his agencies to review …………. a system called ICRHA – that would sever the traditional bonds of trust between an employer and its employees.

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Drug Barrons Build Walls & Traps

June 28th, 2021

“Hey Luigi, how’s that wall coming”

Dominant drug manufacturers use rebates to keep lower-priced drugs off the market……..

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RBP Vendor Embraces PPO Strategy

June 27th, 2021

A case of Wanting His Cake and Eat It too……..A half pregnant attempt towards solving health care……………….

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Federal Appeals Court Revives Dummy-code Lawsuit

June 27th, 2021

“Evidence included correspondence showing Aetna literally told Optum to “bury” its fees by using a dummy code…..”

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Court Finds Cross Plan Offsetting A Prohibited Transaction

June 25th, 2021

The insurer’s use of a pooled bank account also suggested an ERISA prohibited transaction because it made Plan A’s interests adverse to those of Plan B……………

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Where Were The Math Teachers?

June 25th, 2021

Teachers demanded more money in order to spend more money on….. (drum roll please)….. HEALTH INSURANCE.

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Centivo acquires assets from Apostrophe, Inc.

June 25th, 2021

Buffalo, NY, June 23, 2021 – Centivo, a health plan for self-funded employers anchored around leading providers of value-based care, announced today that it has acquired certain assets, including select client and healthcare provider relationships and intellectual property, from Apostrophe Inc., a Denver-based health benefits platform and third-party administrator, effective immediately.

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Ramos vs Banner Health

June 23rd, 2021

Tenth Circuit Makes Clear That Arms-Length Service Agreements Without Evidence of a Prior Relationship Are Not Prohibited Transactions

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Second PBM Reform Bill Becomes Law in Texas

June 23rd, 2021

Second PBM Reform Bill Becomes Law in Texas

“Texas HB 1919 became law last week. The bill prevents PBM self-dealing by prohibiting them from steering patients to affiliated pharmacies. It is the second PBM reform bill to become enacted recently in Texas.”  MORE >>

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Why Was News of India’s Success With Ivermectin Suppressed?

June 22nd, 2021

I have grown more cynical as this Pandemic became politicized. Therefore this sentence is even more alarming…

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TPA Demands NDA (or else!)

June 22nd, 2021

Our compliance team has been auditing our records and it was identified that we do not have an NDA for you.  (So?)

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Texas School Districts Face Decision Deadline

June 21st, 2021

Texas school districts have until December 2021 to make a decision they haven’t had to make in the past 20 years. Do they stay with the TRS ActiveCare government health plan or do they choose coverage in the commercial market?

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Why I No Longer Believe Gov’t Health Care Can Work

June 21st, 2021

Barack Reacts To Article

“I Was a Physician at a Federally Qualified Health Center. Here’s Why I No Longer Believe Government Health Care Can Work.” – Rebekah Bernard M.D.

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School District Alert: Beware of Health Insurance Cooperatives

June 20th, 2021

Dozens of school districts left scrambling to pay $11.6 million in debts, a financial shipwreck that raises concerns about such ventures, which are virtually unregulated……

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FAKE NEWS: Cheap Insurance

June 20th, 2021

More than one million individuals chose a health plan that has a monthly premium of $10 or less….

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How America’s Top Hospitals Pound patients With Predatory Billing

June 16th, 2021

A new analysis reveals that many of the top hospitals in America pursue patients with lawsuits and other predatory billing practices

How America’s top hospitals send patient costs soaring (axios.com)

Individual Health Insurance vs Group Insurance

June 16th, 2021

Adios Group Insurance 

“Instead of employers purchasing insurance plans on their employees’ behalf, they should give their employees pre-tax cash in an HRA, with which employees can purchase ACA-compliant plans”

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Easy Decision

June 15th, 2021

Why would a school district stay with a failing government health plan, be held hostage for five years, have no control over plan benefits or rates when they can access the open market with some very good options that guarantees market rates, better benefits, guarantee issue with pre-existing conditions covered immediately?

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Employer Can Demand Vaccination As A Job Requirement

June 14th, 2021

“You must be vaccinated against (insert name of disease here) or lose your job!”

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CPO’s Beat PPO’s Everytime

June 14th, 2021

Several of our clients have established cash pay centric health plans with good success. Plan savings are similar if not better that what one can expect from a RBP plan and it is certainly much better than a PPO plan.

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Golden Parachute For Texas School Districts?

June 13th, 2021

One of the best kept secrets few are aware of is a golden nugget imbedded in the Texas Insurance Code…………………..

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Hurry, The Bus Is Leaving The Station!

June 11th, 2021

Bus driver Ms. Katrina Daniels smiles as her bus fills up for a five year bus ride to Less Choice, Texas.

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Why Your Health Care is Tied To Your Job

June 11th, 2021

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How Much Do You Charge?

June 10th, 2021

“Your Fees Are Too Damn High!”

By Bill Rusteberg

Early in my presentation yesterday I was asked “How much do you charge?”

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New Blood Test Detects More Than 50 Types of Cancer

June 9th, 2021

Blood test could reduce 5-year cancer mortality by about 40%……………

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2022-2023 Health Insurance Options For Texas Public School Districts

June 8th, 2021

With the passage of Senate Bill 1444 (SB 1444) Texas public school districts may elect to exit the TRS ActiveCare (TRSAC) program effective September 1, 2022.

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The Reasons Why Most Texas Public Schools Will Stay With TRS ActiveCare

June 5th, 2021

Back in 2001, right as the Texas legislature passed TRS ActiveCare, I visited with a Superintendent of a district we had insured with Mutual of Omaha.

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TRS ActiveCare 2021-2022 Renewal Presentation

June 4th, 2021

April 3, 2021

TRS ActiveCare officials met to finalize the TRS ActiveCare 2021-2022 plan year.

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