Risk Managers – Thought Leadership on Health Insurance

West Texas Hospital Administrator VS RBP Rable Rouser

Lubbock Texas is a two-hospital town supported by managed care plans including Medicare and Medicaid. Commercial insurance plans, 100% of which are managed care plans too, subsidize Medicare and Medicaid patient because hospitals say they do.

Legislation Introduced To Fix The No Surprises Act Arbitration Process

When You Can’t Get It Right The First Time….

“The arbitration process (IDR) is clearly not working. A few bad actors—largely backed by private equity—are gaming the system……………..”

Why Your Group Health Plan Feels Like a Group Project That Never Ends (And How ICHRA Fixes It)

By Michael Reagan, CBPA – October 10, 2026

Remember when health benefits were simple? You picked a carrier, hoped the renewal didn’t make you cry, and spent the rest of the year explaining why Brenda in accounting still can’t find an in-network dermatologist. Those days are mostly gone.

Another School District Health Plan Serving 100 Districts Bites The Dust……….

By Allison Bell, BenefitsPro, 10/2/2026

Idaho school districts used the trust to provide medical, dental and vision benefits.
The trust served 16,500 school district employees and dependents.
The trust was not backed by the state guaranty fund.

PPOs Double Your Pleasure, Double Your Fun….

“Double your pleasure, double your fun with double mint, double mint, double mint gum.”

RiskManagers.us Business Statement

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

HR Executives Face Unprecedented Personal Liability

HR Director Reacts After Served With Lawsuit

“A perfect storm of Supreme Court decisions, aggressive litigation and emerging technologies is exposing HR executives to unprecedented legal liability, even for decisions made by their outsourced partners.”

Risk Tolerance – The Fundamental Basis of Goal Setting

“The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.”

Brownsville ISD Believes In Magic

Live Stream | Brownsville ISD – Start 1:36 through 1:55

At their October 6, 2026 board meeting the Brownsville Independent School District trustees, facing a $28,000,000 deficit on their self-funded health plan, approved a one-year extension to make it worse.

Public Filings Expose Voluntary Benefits Commissions to ERISA Litigation Risk

“Plaintiffs are borrowing legal theories long used in retirement-plan fee cases, including breaches of prudence and loyalty, failure to monitor and prohibited transactions….”

Big Pharma Sues Over Lower Drug Prices

Reuters

By Michael Erman

Oct 7 (Reuters) – The pharmaceutical industry’s top lobby group ⁠on ⁠Wednesday sued to invalidate one piece ⁠of the Trump administration’s efforts to benchmark US drug prices to lower costs overseas in the Medicare health insurance program, arguing that it is an illegal overreach by the US government.

UHC Golden Rule Commission Bonus Opportunity

If you are a consumer, don’t read this top-secret insurance posting……………

Holy Voluntary Benefits Batman

By Trey Shields

Aon rained all over Macy’s parade, allegedly. Snagging $13.2M in commissions out of just $36.1M in premiums?

Carvan Coverage LLC

Micromanaging Insurance Committees

“When you micromanage, you’re telling your team you don’t trust them.” – Simon Sinek

Pharma USA 2027

North America’s largest cross-functional pharma gathering………..

Following the launch of Reuters Events Pharma USA 2027, we’re now looking to recognize the innovators and future leaders shaping the next chapter of Pharma.

Insurer of Last Resort

“No problem Joe, I’ll make a call for you”

The obituary is fake. George Parr, The Insurer of Last Resort, is alive and well……….

How Medicare Premiums Are Calculated and Set

Over 20% of the U.S. population are Medicare beneficiaries. Medicare is described as health insurance but it’s not. It’s a government tax-based pool of money used to pay for the health care needs of mostly old people……….old people who have paid into the pool all their working lives and most if not all continue to pay whether they use it or not. What they pay is called premiums.

Trump to Give $90 to Senior Citizens for Medicare Premiums

By Kaanita Iyer, Tami Luhby, CNN – October 3, 2026 – Source: CNN

President Donald Trump said late Friday he will give around 20 million senior citizens $90 each to help pay for their Medicare Part B premiums, marking his latest effort to dole out funds to certain Americans weeks before the midterm elections.

Government Approves Reference Based Pricing Plans for 2028

“Health plans that aren’t built around provider networks will be allowed on the ACA individual marketplace beginning in 2028, marking a structural change to a system that has operated exclusively on network-based models since the ACA launched more than a decade ago.”

Network Plans Save Money

Nothing complicated about it. Network plans improve mental health and save money at the same time………

By Bill Rusteberg

Everyone loves their health insurance plan. High deductibles, ever higher out-of-pocket costs, and narrow networks encourage patients to avoid the stress and expense of accessing care when needs arise. Maintaining mental health has never been easier.

Dry Cleaning Insurance

New niche market for brokers seeking relevancy in the dry-cleaning business.

Tips for Fee-For-Service Doctors

Now that there are no taxes on tips, more doctors are taking notice. What better way to wean off the fee-for-service teat than to work for tips.

Former Hospital Administrator Does A Benedict Arnold

Former hospital administrator moves to the other side of the table, using his insider knowledge to help plan sponsors manage their healthcare dollars wisely……

Rx Prices – You Can’t Fix What You Don’t See, You Don’t Know What You Don’t Know………..

“You can’t fix what you don’t see. You don’t know what you don’t know. We see opportunities others miss. We do what others don’t. Winning together is our goal” – Bill Rusteberg

By Mike McLain

The drug costs $133 a year at cash price. The JPMorgan plan paid $74,751…….1 employee. 1 generic drug. 12 fills.

RiskManagers Business Statement

County Raises Sales Tax To Support Health Care Needs of 700,000 Residents

Sales tax increase expected to raise $1 billion annually to benefit 700,000 residents and punish hospital ERs.

The Math Behind Stop Loss Renewals

By CJ Jordan

Your high stop loss renewal is a function of a bad math problem. The math doesn’t math. Let me explain.

Brownsville ISD To Renew with UnitedHealth

Long drawn-out proposal process is finally over after endless meetings and vendor presentations……………….

At their upcoming October 6, 2026 regular Board meeting district trustees will consider an action item to renew third party administrative services for their self-funded health plan with United Healthcare of Houston, TX.

Blue Cross Blue Shield: AI-Assisted Medical Coding Added $1 Billion in Hospital Costs

Hospitals’ growing use of AI to assign medical billing codes contributed close to $1 billion in extra costs for Blue Cross Blue Shield health plans between 2023 and 2025, according to a new analysis from the insurer’s trade association. 70 percent of the additional cost involved additional diagnoses that did not change patients’ actual care, according to the insurer, which describes the situation as a “clear disconnect between coding and treatment.”

The Stop-Loss Market is Hung Over

By Craig Gottwals – Attorney & RBP Expert – October 1, 2026

Higher claim severity, tighter underwriting, and strained carrier economics are driving 2027 renewals.

In 23 years of installing self-funded health plans, I cannot remember a medical stop-loss market quite as constipated as this one.

The Neighbors Came First: What a Century of European Health Cooperatives Teaches American Policymakers and Investors

By Dave Chase – September 28, 2026

In 1899, sixty members of the Catholic Workers’ Association in Switzerland promised to help carry each other’s costs when illness or accident struck. That promise became CSS, which now insures about 1.7 million people, almost one in five Swiss, and still belongs to the association that grew from its founders.

Mark Cuban: Why US Hospitals ‘Don’t Know Their Costs’

By: Alan Condon – September 1, 2026

Mark Cuban argues the fundamental problem in U.S. healthcare is not whether the system is run by the public sector or the private sector. It is that hospitals do not know what their own services cost.

Dr. Oz Pitches CHOICE Health Plans

Choice Is An Everyday Event…………………………..

“For too long, employers and workers have been stuck with a one-size-fits-all approach to health benefits,” Dr. Oz said in a news release. “CHOICE changes that by giving businesses greater flexibility and giving employees more control over the coverage that works for them.”

Texas System Sets World Record As Largest Medical Center

By: Paige Twenter – September 21, 2026

Houston’s Texas Medical Center has been formally recognized as the world’s largest medical complex, a title the 1,345-acre campus has long claimed for itself.

Invertebrates Are Status Quo’s Best Friend

“Demonstrated reluctance to consider suggested strategies indicates a growing tendency towards static risk management which is contrary to proper oversight. We bring no value in exchange for the fees you pay us when the status quo isn’t continuously challenged with evolving strategies and a wiliness to act when it’s in the best interests of the plan and plan members no matter how hard change may be.”

Willacy County Did What!

In August the Willacy County Health Plan awarded TPA services to 90 Degree Benefits for an October 2026 effective date after a competitive Request for Proposal process. Now we learn another TPA has also been awarded the contract ostensively for the same effective date.

Parasitic Disease Epidemic Decimates Working Americans

By Taryn Shipley, MBA, CSSBB

Insurance companies are a parasite on the US healthcare system. Look at how much of Epic exists just to navigate insurance.

Cutting Out PPO Middleman

More plan sponsors are beginning to understand PPOs bring no value to health care financing, only higher costs turbocharged by annual escalator clauses……

How AI Is Already Changing Health Plan Administration

By Dan Thompson – SOURCE: HVBA

For decades, open enrollment has followed the same script: a flood of PDFs, a confusing comparison chart, either in a printed guidebook (that had multiple versions) or on a digital handbook that is emailed out to employees. This is coupled with a benefits team inbox buried in questions, and employees clicking through choices they only half understand — maybe.

Angle Health – A $2.7 Billion Insurance Company You’ve Never Heard Of…..

Bet you’ve never heard of Angle Health. It’s different. Imagine getting a firm quote in minutes rather than waiting days and weeks to get quasi-firm quotes from legacy brokers and stop loss carriers.

Have PPO Networks Perpetrated The Greatest Heist In American History?

“Understanding the cost of health care is directly related to what we agree to pay, more and more employers are questioning managed care contracts upon which their health care costs are based. Many are discovering the truth for the first time.”- Bill Rusteberg

Oklahoma Insurance Commissioner Sounds AI-insurance Fraud Alarm

By Maura Keller

As artificial intelligence becomes more accessible, it also creates new opportunities for criminals to commit increasingly sophisticated insurance fraud, according to the Oklahoma Insurance Department and Insurance Commissioner Glen Mulready.

The Fox Guarding the Health Plan

By Craig Gottwals – Cutting Healthcare Spend 20–40% for Lean-Margin Businesses | Attorney & RBP Expert

September 28, 2026

How a Federal Court Ruling Exposes the Structural Conflict in Bundled Health Plans

When Did Saving Money Get So Expensive?

“The cost containment industry exists to reduce healthcare spending. Somewhere along the way, however, the cost of achieving those savings became a business model of its own.”

“Percentage-of-savings fees are common across the industry, and depending on the service and arrangement, those fees can consume a significant portion of the savings generated for a health plan.”

AG Paxton Launches Investigation of Blue Cross Blue Shield

Investigation stems from company’s denials and delays of urgent medical care

TEXAS – Texas Attorney General Ken Paxton has launched an investigation into Blue Cross Blue Shield of Texas, its parent company, Health Care Service Corporation, and related entities over allegations that the insurer denied or delayed coverage for medically necessary and urgent care.

73% of Small To Midsize Employers Consider Dropping Traditional Health Insurance

Survey: 54% of Small- to Mid-Sized Businesses Report Double-Digit Health Plan Premium Increases for 2027

Direct Contracting Is Not A New Idea

By Michael Reagan, CBPA – September 28, 2026

Direct contracting is not a new idea. It is the original American hospital plan — and we have spent nearly a century burying it under intermediaries.

Fascinating Times For Direct Primary Care

“People will start treating health insurance like car insurance. You only use it when you get hit. For everything else? They want a doctor who knows them. Who cares. Who gives them time”

The Post-Network World of a Cash Economy

By Katy Talento – CEO | Former White House Policy Advisor | Media Commentator, Writer, Communicator and Influencer | Recovering Epidemiologist | Naturopath. Hacking the systems that control our health.

The post-network world of a cash economy may be the only hope for saving health care, which is otherwise headed toward such unsustainable costs, grievous harm to patients and moral injury for everyone involved. BUT that world can’t come if the vast majority of patients are served through their employer plans that are run by networks.

AON Buys Relationships For $17,000,000,000

Relationships are worth something. You can sell them, destroy them or buy them. Buying them is a faster and cheaper way to grow your business. This is how Gallagher, Willis, Higgenbotham, USI, Marsh and other national brokerages expand their book. It’s similar to a franchise model – Bill Rusteberg

Sales Trivia

Worst sales close ever devised by mankind – HERE

Third Party Insurance Compliance Risk Manager

Your contractual indemnity is only as good as their balance sheet

The MSA says the vendor indemnifies you. If the insurance behind that clause isn’t there, you are indemnified by a firm with eleven employees and a van.

4 Out of 5 Doctors Employed, 18% Left Standing

Here’s another reason Direct Primary Care is growing rapidly across the country. Consumers demand better access, employers demand lower costs, and physicians want back their freedom to do what they are trained to do without third-party interference. Corporate owned physicians solve none of those problems, only exacerbate them – Bill Rusteberg

LicenseUp Has Officially Launched In Texas!

LicenseUp is a nonprofit 501(c)(3) organization dedicated to reducing barriers to careers in the insurance industry. Students can now prepare for Texas insurance licensing exams with our free online courses:

BUCA Lies While Smiling

A True Story By Bill Rusteberg

A large Texas group plan is fully-insured with a major BUCA. The carrier touts their all-in retention charge is the lowest in the industry at less than 10%. That’s a lie.

The Love-Hate Broker Relationship

By 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.

Next Level Prime – A Direct Primary Company, Gains 11,000 Members In Corpus Christi….

Next Level Prime, a Direct Primary Care and Urgent Care organization has picked up 11,000 subscribers in Corpus Christ, Texas.

Anti-Fraud Task Force To Axe +500,000 Off Obamacare & Shitcan Wayward Agents

Officials said 40 insurance agents and brokers were responsible for creating 50,000 fake accounts at a cost of $45 million — and CMS had already axed 66 agents from its system………… The agency also intends to shed 469 additional agents, according to the report.

Independent Oversight For Employer Healthcare

Most employers have never had an independent review of one of their largest operating expenses.

Benefixa gives leadership a clear view of what’s driving costs, where money is being left on the table, and whether better outcomes are possible — without requiring broker replacement or disruption to your current team.

Aetna Sells Dual Option PPO – RBP Plans!

By Bill Rusteberg

Aetna has been selling Reference Based Pricing plans alongside their PPO network plans for years but nobody noticed.

Forbidden Access & The Rise of Cash Pay Insurance

By Bill Rusteberg

In the beginning Reference Based Pricing plan members enjoyed almost unfettered access to hospital care. Hospital intake clerks were often fooled into believing RBP members belonged to hospital approved provider networks because more common than not there was a recognizable managed care logo somewhere on member’s I.D. card. What they didn’t realize was that network access was for professional care only, not hospital care.

Taxpayers Gift Texas Hospitals Another $12,000,000,000

Here’s how it works: Millions of Americans take home less money after government skims off the top of their earnings (taxes) while an equal number of Americans don’t pay taxes at all. Complicit employers under threat of punishment send the juice to Washington so 435 people (Congress) and their bureaucrat lackeys can have their way with it. In this instance, it’s decided to gift $12,000,000,000 to Texas hospitals in order to turbocharge payments from yet another taxpayer funded gift (Medicaid).

Meanwhile back at the ranch, with what’s left of their paychecks, working Texans struggle to afford health insurance that’s so bad they can’t afford to use it either while 435 people and their bureaucrat lackeys enjoy the best health insurance money can buy paid for by the people who can least afford it.

Large Texas School District Searches For Missing Lost History

“I don’t know what our lost history is. We need an expert to do that” said the district’s administrator in charge of the district’s $71,000,000 self-funded health plan during a recent insurance committee meeting.

Brownsville ISD – As The World Turns (Upside Down)

Here’s another episode of BISD’s As The World Turns series. In the last episode, Brownsville ISD Enters The Twilight Zone, frustrated trustees are besides themselves. “Why can’t we get answers to basic questions!” said a board member. “You better be prepared next time!”

Medicus Pharma Ltd. (MDCX)

Alliance Global analyst Matthew Venezia raised the firm’s price target on Medicus Pharma (MDCX) to $1 from 90c and keeps a Buy rating on the shares following a transfer of coverage.

If We Can’t Find Emails & Phone Numbers, No one Else Can

Stop missing out on deals because you can’t find your leads’ contact information. 80%+ find rate.

Proposed Medicare Change Would Cut Reimbursement by 50%

Independent physicians will face a moral calculation with every Medicare patient ……………………….

Be Prepared – Storm Season Is Here

Reputational Risk Management

Craig Gottwals – Attorney & RBP Expert

They used to be called brokers, then consultants, then producers. Now, advisor seems to be the preferred happy term. Or maybe just the non-descript VP.

United HealthCare’s Reach Is Massive

By Xandra W.

Forget the bogus 32% stat for a second. The REAL story is that one company can insure you, employ your doctor, manage your prescriptions, process your medical claims, own the technology behind the system, and then make BILLIONS while deciding what care gets paid for.

The Cash Movement Is Growing

“The cash movement is growing. Its scary at first because you don’t know what to do against something very expensive. But healthcare billing and finance is all fake. As soon as you probe a little bit prices come crashing down. Please come and join the price transparency movement”