Risk Managers – Page 2 – Thought Leadership on Health Insurance

What Took So Long? This Has Been Going On For Years!

By Dave Chase

For decades, benefits consultants operated under a simple protective claim: “We just advise.” Schlichter Bogard just demolished that defense & put them on a map no one wants to be on.

How To Stretch A 10 Second Decision To Infinity

A True Story By Molly Mulebriar

Take a ten second decision where everyone wins and nobody loses to a political subdivision then start your stop watch. You will be amazed how long a 10 second decision actually takes.

The Rise of ERISA Health Care Class Action Lawsuits

By Steve Ditto

Healthcare just crossed into its 401(k) moment. The law firm that forced fiduciary accountability into retirement plans has now filed healthcare ERISA class actions.

PBM Three Card Monte

By George H. George

Your PBM just charged your plan $2,847 for a prescription. They paid the pharmacy $340. They kept $2,507 as “spread.” You’ll never see it on your invoice.

No Surprises Act – Supreme Court Petitioned To Review Enforceability

Should the Supreme Court grant cert, the outcome of the case could have broad implications for the enforceability of NSA arbitration awards, a key feature of the NSA’s regulatory framework.

Private Practice Is Dead…..If You Take Insurance

“Here’s the truth, taking insurance can work but it’s very painful. You have to run a volume based practice, see lots of people and have complicated systems set up, for it to run well.”

Discrimination Runs Rampant In Legacy Health Insurance Plans

Illustration By Dutch Rojas – The Rojas Report

By Bill Rusteberg

Health insurance is a reimbursement benefit for a covered loss. Although plan members each pay the same premium, some receive greater benefits than others.

Do PBMs Know The Exact Amount of Rebates Per Prescription?

There’s been a discussion this week on Linkedin about whether PBMs can provide detailed quarterly rebate settlement accounting for plan sponsors.

RiskManagers 2025

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

100 Best Health Insurance Blogs and Websites in 2025 – RiskManagers.us ranked #10 in the 100 best health insurance blogs from thousands of blogs on the web ranked by relevancy, authority, social media followers & freshness.

Bette Nesmith

By Michael Magri

Dallas, Texas, 1954. Bette Nesmith was drowning. A divorced single mother raising her young son Michael on a secretary’s salary of $300 a month, she had dropped out of high school at seventeen.

Most Read RiskManagers.us Blog Article of 2025

Posted November 30, 2025 this blog entry has received +16,000 viewers, all in the past 60 days.

LBJ Signs Medicare Into Law – Was Ronald Reagan Right?

Medicare will be 60 yeas old July 2026. Was Ronald Reagan right?

City Gifts $2M to Local Hospital

City of Brownsville invests $2,000,000 in local hospital under Chapter 380 of the Texas Local Government Code.

The Myth of Nationalized Healthcare

The UK Health Care Disaster is a Cautionary Tale for America’s Rising Class of Armchair Socialists

The Washington Post shocked many of its Democratic readers this week by telling the truth about the growing disaster in the UK’s National Health Service — a cautionary tale as a few Republicans plan to join Democrats to extend the failed Obamacare subsidies rather than reform our own broken health care system.

A Surprising Treatment for Chronic Lower Back Pain: Cannabis

Two new drug trials find a THC-based cannabis extract could help with a condition that affects millions

6,240,000 Patients On Waiting List

There were 6.24 million individual patients waiting to get treatment in England as of October. That’s about 1 in 10 people in the country waiting in the queue.

Need Surgery But Don’t Have Insurance? No Problem………..

Pre-Existing Conditions Waived After 21 Days

Imagine needing some sort of surgical procedure but you don’t have insurance. No problem, book a flight to Costa Rica 21 days in advance, buy travel health insurance at the same time, and make your surgical appointment upon arrival at San Jose airport.

FLIGHT INSURANCE KIOSKS AND THE JET AGE

Travel Insurance Kiosks at Detroit’s Willow Run Airport, 1954. Part of the “Old News” collection at the Ann Arbor District Library.

SOURCE: FLIGHT INSURANCE KIOSKS AND THE JET AGE — Jet Age Art

While researching the fight insurance angle for my TGA (“Airport” movie) Ticket Package assembly, I discovered a rich, although brief history of airport flight insurance sales. It all started with the “Great Lakes Fidelity” Airline Trip Insurance Receipt I had to design, as a major component of the overall ticket package, as fans of the “Airport” movie or novel know.

Modifying the ACA Maximum-Out-Of-Pocket Mandate

There’s More Than One Way to Skin a Cat

By Bill Rusteberg

Under the Affordable Care Act (ACA) once a plan member meets their out-of-pocket annual maximum the phenomenon of moral hazard is fueled. When other people’s money are funding health care expenses there is no incentive to address cost and needs.

2026 Insurance Industry Predictions

The Year Constant Evolution Becomes Competitive Advantage

“The insurance industry stands at a defining moment in 2026 where legacy approaches no longer match the pace of change. Carriers face mounting pressure: cyber threats target their infrastructure, customers demand personalized products that evolve in real time, and converging risks—from climate volatility to AI liability—challenge traditional models.

Ronnie Lockwood

We invited a man into our home at Christmas and he stayed with us for 45 years

100 Best Health Insurance Blogs and Websites in 2025

#10. RiskManagers.us

RiskManagers.us ranked #10 in the 100 best health insurance blogs from thousands of blogs on the web ranked by relevancy, authority, social media followers & freshness.

Find Hospital Pricing In Seconds

Ask about pricing strategy, market rates and competitor contracts – explore the data yourself HERE.

These Are Your Problems If You’re Using Blue Cross

“If you have a BCBS plan, this is happening to you. It doesn’t matter what they promised in the RFP. It doesn’t matter what the glossy sales deck said. It doesn’t matter what they tell you in meetings. This document governs what actually happens to your claims. And once you read it, you’ll understand why fiduciaries should be very, VERY, uncomfortable.”

Hospital Demands Blue Cross Pay More Than 120% of Medicare

Hospital sues BCBS of Alabama over reimbursement amid bankruptcy

Breaking News: Oral Weygovy for $150/mo.

By Stacie Mays

Breaking news…Oral Wegovy was approved yesterday, with Lilly’s Zepbound expected to follow in the next few months. Both companies have agreed to sell the drugs direct-to-consumer for $150/month for the lowest dose.

Santa Carl

Carl Schuessler, Inventor of The Schuessler Stick™ On His Way To Work

Rare photo shows Santa Carl racing to work, bringing peace, joy and magical wonders to struggling plan sponsors all across the Fruited Plains this Christmas season.

100 Best Risk Management Blogs and Websites in 2025

The best Risk Management blogs from thousands of blogs on the web and ranked by relevancy, authority, social media followers & freshness.

Pet-USA™

75% of claims paid within 24 hours, 95% within one week. Rated best pet insurance on the market.

When Can Medicare Patients Pay Cash?

By David Holt – June 5, 2025

For providers who treat Medicare beneficiaries, the rules around accepting cash payments are anything but straightforward. While it may seem reasonable to allow a patient to pay out-of-pocket for convenience or privacy, federal law places strict limits on when that’s allowed.

Payment Infrastructure Modernization for Healthcare

The U.S. healthcare system wastes $200–350 billion annually on administrative friction—billing complexity, payment delays, prior authorization bureaucracy, and claims rework.

TRS ActiveCare Seeks TPA Services

TRS seeks a qualified vendor(s) to provide one or more of the following types of services: (1) TRS-ActiveCare Program enrollment administration and TRS-ActiveCare Program District Liaison Team services; (2) TRS-Care Program direct billing services; and/or (3) TRS-Care Program enrollment administration services.

The 2026 TRS ActiveCare Blitzkreig Continues

Grand Prairie Independent School District joins a growing list of Texas school districts wanting out of the health insurance business.

How To Solve The High Cost of Man-Made Health Care

By Bill Rusteberg

FORMULA: Defined Contribution + Indemnity Fee Schedule (Eliminate/outlaw % of billed or allowed charges) and presto, you get the American middle class back in play.

HOW THE AMERICAN HEALTHCARE SYSTEM BROKE & WHY NOBODY FIXED IT

PIM Health | Payment Infrastructure Modernization for Healthcare

The most important stakeholders in American healthcare are unhappy. That’s mainly an architecture failure, not policy…well, maybe some policies.

The Largest European Broker

Serving Clients All Over The World

Howden is a specialist insurance broker. We combine the strength of a global broker with the personal touch of a group with employee ownership at its heart.

Look Up Where Your Generic Prescription Drugs Were Made

SOURCE: ProPublica

The FDA won’t tell Americans where their generic drugs are made, so ProPublica did it instead. Use information on your prescription label to locate the factory and see inspection reports.

More Texas School Districts Throw In The Towel – Join TRS ActiveCare Government Health Plan

Give Me Your Poor, Your Tired, Your Huddled Employee Masses………….

Santa’s Adverse Selection Elves have been busy this year. As many as 40 Texas school districts are reconsidering their risk management strategies and may join the TRS ActiveCare government health plan in 2026.

RiskManagers 2026 Fee Schedule

Over the years when meeting with prospects for the first time we were invariably asked “How much do you charge?” Instead of dancing around the subject as most in our industry seem inclined to do, we decided to publish our fee schedule for the world to marvel at. We’ve done that every year since, and we will continue to do that until we turn room temperature which we hope doesn’t happen any time soon.

No Deductibles? No Co-Pays? Is This Texas-Based Health Insurer Too Good to Be True?

Fred Turner, CEO & Co-Founder of Curative Insurance Company

Curative says it can turn profits without its customers facing the usual out-of-pocket costs or high premiums. Economists have their doubts.

Your Plan Is Only As Trustworth As The Weakest Vendor In Your Ecosystem

By Sunil Vasisht

Your plan is only as trustworthy as the weakest vendor in your ecosystem…but nobody is addressing that!!…

Once Upon A Time I Was A Traditional Health Insurance Broker, The Easiest Job In The World

By David Contorno

I know I’m going to get a lot of flack for this, but here goes. And I challenge anyone who pushes back to tell me where I am wrong.

Reminder—Gag Clause Attestation Due December 31st

December 16, 2025 – Haynes Boon

Group health plan sponsors must file the annual gag clause attestation required by the Consolidated Appropriations Act of 2021 by December 31st on the CMS website (here).

How To Solve The High Cost of Healthcare in 24 Hours

Outlaw Assignment of Benefits & Watch What Happens

Amarillo ISD’s 2026 Risk Management Strategy Unveiled In Time For Xmas

“Merry Christmas TRS ActiveCare, there’s a $20,000,000 lump of coal in your stocking” – The Amarillo Independent School District.

LOWER COSTS.MORE POWER – SHOW US YOUR PRICES

“When every patient and employer can see prices, markets will clean out waste on their own… The ripple effect — lower costs, higher wages, more investment — will strengthen every part of the economy. If America truly wants to make life affordable again, healthcare transparency is where we start.”

‘We Are Dying’: Cuba Sinks Into A Health Crisis Amid Medicine Shortages and Misdiagnosis

Cuba today is indeed a country of sick citizens who do not know exactly what they are suffering from.

ObamaCare: Consumer Deception and Taxpayer Fraud

By Ge Bai

ObamaCare subsidy fraud occurs because government agencies care little when spending taxpayers’ money, and insurers and brokers have no incentive to stop it.

Amarillo ISD Wants Out Of The Health Insurance Business

Amarillo ISD Says “NO MAS!”

Trustees will consider an action item to join the TRS ActiveCare government plan at today’s 5:00 special called meeting.

Brownsville ISD Decides Cash Is Better Than Benefits

Brownsville ISD Puzzle Palace

Despite continued deficit spending on their self-funded health plan the Brownsville Independent School District has gifted $5,000,000 in taxable income to +6,500 employees at a rate of $750 each whether they earned it or not.

Confidential Failure to Survive Insurance

Your client may find themselves with a financial interest in a third party business associate, who is not insured in their favor. If an untimely death or disability were to happen to the uninsured third party, your client could face a significant financial setback.

Executive Forum 2026 in San Antonio

You’ve already heard about our keynote — now meet some of the voices opening Executive Forum 2026, February 23-25 in San Antonio, TX.We’re not easing in. These leaders refuse to play it safe. They’re here to challenge assumptions, spark candid insights, and set a tone that’s anything but predictable.

Corporate Owned Life Insurance For Slave Owners

Slave owners took out “Corporate-Owned Life Insurance” to protect their most valuable asset.

2020 State Employee Health Plan Rates

The chart shown above is 5 years old and compares various state health plans for public employees.

The 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.

100% Suffer ACA Consequences For 10% of The Population

By Bill Rusteberg

Under the heavy hand of punishing government diktats, the Affordable Care Act has not delivered on its promise of affordable health care for all. It has, however, delivered promised affordability for a small subset of the American population. The consequences have been devasting to the American middle class.

Aldeen’s Sunday Morning Bathroom Read

Across The Country IDR Filings Have Skyrocketed.

“Under Medicare, the procedure reimburses about $1,145. But through arbitration, this practice has routinely secured average awards exceeding $100,000…… The NSA/IDR is a growth business and there is zero incentive for OON providers to fairly contract.”

Government ACA Subsidies

“Does government funding of something unaffordable make it affordable? Does it lower healthcare costs? Or increase healthcare costs? There’s a silver lining here. Don’t you see it? – Bill Rusteberg

Stop Loss Application Disclosure

“Once you know some things, you can’t unknow them. It’s a burden that can never be given away“ – Alice Hoffman

Reference Based Pricing Rationale

Taiwan Took a Fresh Look at Healthcare — and Designed Something Remarkable

By Sherrie Mancini

One of the most inspiring examples in global healthcare reform comes from a country many don’t realize is fully capitalist: Taiwan.

Amazing Transformation

By Nicole Miles

At 300 pounds I was leading an open enrollment meeting teaching people to take care of their health Then I heard it, that cough-laugh from the back of the room,
the one that hits you in the gut.

It’s Over – Senate Rejects Extension of Health Care Subsidies

Nope, it’s not over. It’s only a temporary delay.

Republicans Have No Plans To Fix Obama Care

House Republican leaders presented no firm plan Tuesday for advancing health care legislation as anxiety rises in the GOP ranks over the impending expiration of key Obamacare subsidies at the end of the year.

Breaking News – Mental Health Breakthrough Rocks Academia

Mental health experts express disbelief. “Never in all our clinical studies did we ever see an apparent sustained remission like this!” said Dr. Hornsberry, professor of mental health studies at the University of Texas.

How Cash Transforms Health Care Financing

Manufacturers have reduced GLP-1 drug prices to $299–$349/month for cash paying consumers, a 70%+ drop from 2021 prices.

End Obamacare Subsidies – Fund The Patient

“Imagine Americans receiving deposits into HSAs to pay for cash transactions and premiums for patient-driven insurance plans, backed by taxpayer-funded reinsurance as a safety net…” – Ge Bai

The Health Care Freedom for Patients Act

Senate Publicans plan to offer an alternative health care bill as Democrats seek to extend tax credits.

Status Quo Health Care Financing

Two BUCA brokers on the way to a prospect meeting:

The Empty Surgery Center

By Dutch Rojas

The Empty Surgery Center That Perfectly Explains Why Your Insurance Is So Damn Expensive

The Biggest Misconceptions Around Direct Primary Care

By Colton Storla, CPBS, GBDS – December 9, 2025

The same pushback comes up in almost every conversation I have with employers about DPC. Let’s clear up what’s real and what’s just noise.

The Only, Plug & Play, ICHRA + Personalized Benefits “Operating System” in the Industry

CHRAOS is Your Turnkey ICHRA & Personalized Benefits Solution.

Prepare to Crush Your Competition

The market is changing, awareness and adoption of alternative program designs are growing, but many brokers and employers have yet to implement programs that really deliver meaningful impacts to the end consumers, the employees because they lack the tools to effectively manage them across large populations.

The number of insured pets in North America rose 12.2% in 2024 to 7.03 million, up from 6.25 million in 2023, according to the North American Pet Health Insurance Association.
Pet-USA – Rated best pet insurance on the market. 75% of claims paid within 24 hours, 95% within one week.