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”

Medical Trend Doesn’t Exist, You Just Think It Does

By Bill Rusteberg

Medical trend is driven by managed care contracts and has little to do with cost of health care and everything to do with the cost of health insurance.

Lasers Are To Die For

By Bill Rusteberg

Lasers are to die for. We should love them! I’d rather take a chance than pay an upcharge for something that may or may not happen.

Will The Free Republic of Liberland Ever Have A Single Payer System?

Liberland is the first decentralised autonomous government and also the world’s ‘freest country’……which means freedom draining government mandates like the ACA won’t ever see the light of day…………

How To Make Millions Scamming Self-Funded Health Plans

By Bill Rusteberg

Life has never been better for seasoned health insurance salesmen. They know how to stretch plan contributions to their advantage without increasing them. And medical inflation is their best friend, a convenient scapegoat that doesn’t exist yet blamed for cost increases upon every renewal whether deserved or not.

Risky Risk Pools Plague Texas School Districts

“How can a superintendent or school board, as fiduciaries of taxpayer funds, jeopardize a district’s assets by participating in a risk pool, when they have no idea as to the pool’s financial ability to pay losses?” – Robert Reim

Aldeen’s Sunday Morning Bathroom Read

State lawmakers could implement standardized model contracts for state employees, cities, counties and school districts…………..

King Murray – The Most Outrageous Insurance Salesman That Ever Lived!

Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!

Skyward Specialty Insurance

By Arleigh Kennedy – Stop Loss Expert

It’s frustrating how many people still don’t know Skyward Specialty Insurance is a direct writer of Stop Loss. Through our wholly owned subsidiary, Great Midwest Insurance Company (GMIC), we hold the paper, bear the risk, and stand on our own balance sheet. We aren’t renting paper. We are the direct writer.

ATTN. RISK MANAGERS: Here’s A Doozy You Won’t Want To Miss

September 16, 2026 at 5:30 PM – Employee Benefits, Insurance and Risk Management Committee Meeting

Plan Sponsor Achieves The Impossible

QUESTON: How did this midsize group reduce their Rx spend by 45% while all plan members continue to receive the drugs they need? How was it possible to drop their PMPM Rx cost from $133 to $60?

Willacy County To Issue RFQ For Insurance Consultant

The prior consultant who served Willacy County for 20 years resigned effective August 1, 2026. The county is now seeking a replacement.

Another Wisniewski Truth Bomb

By Leon Wisniewski – Revolutionizing Healthcare Spending | Founder @Health Cost Labs | Actuarial & Forensic Audit Expert | 20+ Years of Experience Working in the Healthcare Industry | Top 100 Innovators & Entrepreneurs!

Today the primary reason why healthcare is messed up is because employers give their cash to another vendor to do the bookkeeping. And that vendor proves their value by demonstrating how they pay less for treatments by using a number that never expects to be used for payment.

Trump Plans $500 Obamacare Rebates

Solange Reyner – Wed, September 9, 2026

The Trump administration plans to distribute $500 direct deposits to roughly 1 million people who buy their own health coverage without federal premium subsidies in 30 states ahead of the Nov. 3 elections.

Dr. Juliet Breeze – “Our Story Is For Everyone”

Next Level was founded by Dr. Juliet Breeze, who is also a mother. She experienced first-hand how challenging and expensive it can be to seek care for her injured son at a freestanding emergency room.

Curative Insurance Company Meets With Texas House of Representatives

By John Bock

I wanted to share that our CEO, Fred Turner, recently testified before the Texas House of Representatives Select Committee on Healthcare Affordability and laid out why newer health plans like Curative keep running into the same wall: hospital consolidation.

Brownsville ISD Enters The Twilight Zone

Do-Nothing Meeting – A Must-See Lesson On How To Do Nothing While Trying To Do something………….

The Brownsville ISD Board of Trustees meeting is an amazing example of ineffective leadership and an incompetent administration too scared to act. The meeting revolves around a recent RFP for group health insurance for their $60,000,000 DEFICIT SPENDING HEALTH PLAN…………..that’s currently $20,000,000 in the hole.

Call Me DOCTOR!

Titles mean a lot to some people, especially among educators. Obtaining a PHD isn’t that hard if you know how. Now it’s much easier.

Medicus Pharma Inks Global Licensing Deal With Pfizer Worth Over $1 Billion

Story by Vandana Singh

Medicus Pharma Ltd. MDCX secured on Wednesday an exclusive, sublicensable global license from Pfizer Inc. PFE to develop, manufacture, and commercialize PF-08046031 (CD228V), an early clinical-stage antibody-drug conjugate targeting melanotransferrin.

Lawnchair Larry Had A Different Kind of Pilot Life Insurance

Lawnchair Larry had his own version of a life insurance policy thanks to his girlfriend. She bought Larry a parachute hoping he didn’t have to use it. He didn’t.

Here’s A Texas Health Insurance Company You’ve Never Heard Of…

“We empower families to take charge of their healthcare — equipping them to save money and find providers that align with their value”

The Number 1 Digital Agency For Small Business Insurance

SOURCE: Insureon

Insureon is the #1 digital agency for small business insurance. We’re licensed in every state and have access to 100+ top-rated insurance providers, including The Hartford, Chubb, Hiscox, Liberty Mutual, and Travelers.

Win Government Contracts Before The RFP Drops

Civic IQ monitors council meetings, CIPs, and contract expirations across 100,000+ state, local, and education agencies — and delivers ranked government procurement signals to your B2G sales team before the bid goes public.

The ICHRA Shop Does It Again

By Brad O’Neil

BREAKING: ICHRA is becoming the CHOICE Arrangement—and we were already building for what came next.

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……….

Brownsville ISD Insurance Committee To Address Decision Making Process

The Brownsville Independent School District’s self-funded health plan has a rich history going back years. Now, as we enter yet another episode of “As The World Turns” a BISD board member with a little help from his friends is on the warpath. You don’t want to miss this episode……………….

RiskManagers Website Defies Normalcy Because It Does

How many times have you visited a website and walked away wondering what exactly do they do? That’s by design. The strategy is to create as much curiosity as possible to motivate engagement.

Rx Financing: If It Doesn’t Make Sense It Does

By Bill Rusteberg

Why do we need insurance when 85% of the 26,715 FDA approved drugs covering every therapeutic class are low-cost generics with most costing $4 – $10 for a 30-day supply and the national average including higher cost generics costing an average of $35-$45?

Aon Acquires USI Insurance From KKR in $17 Billion Deal Targeting Middle Market

By Chad Hemenway | August 31, 2026

Aon plc early Monday confirmed a definite agreement to buy USI Insurance Services from private equity firm KKR for $17 billion.

City of Dallas Health Plan Suffers $51,000,000 Budget Shortfall

After layoffs, furloughs, Dallas looks to cut employee healthcare

The changes could affect which doctors employees can see and eligibility for GLP-1 coverage.

Why Healthcare Price Transparency Will Fail

Five fatal flaws — and how putting patients back in control of their own money fixes everything.

Does Commercial Insurance Always Pay More Than Medicare?

By Jason Nakka

Commercial insurance is supposed to pay more than Medicare. That is the whole reason a practice takes commercial patients in the first place.

Employer Sponsored Family Coverage Can’t Compete With Market Place Coverage

Mary, who teaches smartness because she is, learns artificial economics is driving market demand…………….and she gets a self-imposed pay raise.

Independent PCP Considers Insurance Sales

By Bill Rusteberg

In response to a previous blog posting (SEE POSTING HERE) we received an email from a primary care physician we know asking if insurance sales was an opportunity for him and “if so, how?”

Martin Frankel: The Recluse Who Looted Insurance Companies

SOURCE: The Fraud Archive

He was a recluse who hid from the world, then learned how to buy other people’s caution, their trust, and their reserves. Martin Frankel turned insurance companies into a private vault—and tried to wrap the scheme in Vatican respectability.

Mulebriar Strikes Again

“Texas takes unlicensed TPA activity very seriously, especially when municipalities or public funds are involved……..”

American Healthcare Finance – Is History Repeating Itself?

“Distribute a benefit and you distribute dependency. Distribute dependency and you distribute political power to whoever controls the distribution.”

47% of the American population is receiving government funded healthcare……

Teneshia – Houston’s #1 Fiscal Conservative

Credit: KHOU 11

A Harris County official was just approved for a $305,000 salary. She says she won’t take it.

RiskManagers Website Defies Normalcy Because It Does

How many times have you visited a website and walked away wondering what exactly do they do? That’s by design. The strategy is to create as much curiosity as possible to motivate engagement.

Chasing Dollars 7 Minutes At A Time

By Kendrick Johnson DO

I spent years inside the insurance-based primary care system. Here’s the part nobody says out loud: The 7-minute visit isn’t a failure of the system. It’s the output of the system.

Disney Is Dropping Healthcare Coverage For Working Spouses

The Affordable Care Act requires large employers to offer coverage to employees and their dependent children but imposes no obligation to cover spouses…….200,000 Disney employees lose spousal coverage…………….

Medicare For All Is Only One Election Away

“It’s time we eliminate the world’s longest waiting period!“ says Johnny Walker. “Not only is it the longest waiting period known to mankind, it requires decades of prepayment to the tune of hundreds and thousands of dollars before coverage ever begins!”

Small-Town Pharmacist Reveals the Financial Reality of Owning a Drug Store, Says She’s ‘Barely Making Enough’ (Exclusive)

Fair Jones tells PEOPLE she is “working myself to the bone” to save the Mississippi pharmacy she dreamed of owning

“Some can cost the pharmacy $1,000 or more for one patient’s one-month supply, while Jones says she may make only $10 in profit on the prescription. Filling 10 of those prescriptions in a week could cost her $10,000 upfront while bringing in just $100 in profit.”

Negotiating 2027 Renewals with Blue Cross and other BUCAs

By Daniel Meylan – Independent Healthcare Risk Financing Consultant

Over the past week I’ve had multiple advisor conversations across the country from Kansas to Texas to Missouri to Pennsylvania and heard about many Blue Cross fully insured renewal increases that exceed 30%. The way things are shaping up, any 2027 renewal offer from BC under 20% may be considered acceptable, especially for groups of 50 or less.

Government Backed TPAs to Compete With Legacy TPAs?

“The time has come for Congress to give employers a more accountable and affordable option to administer their medical benefit plans. We call this system disruptor the Fair Pay, Fair Play TPA”.

This article says Congress should gift employers a more affordable option to administer their medical benefit plan by competing with greed driven, plan gouging, for profit legacy TPAs.

Humberto Zamora

Humberto Zamora was one of the first entrepreneurs in the Lost & Found Money business who saw an opportunity well before anyone else did. From humble beginnings he earned millions helping hospitals collect Found Money.

IDR Awards Turbocharge Toilet Paper Numbers

“Awards usually land at 3–10× the toilet-paper number. But sometimes it’s 100× or 150×”

Large Texas School District Seeks Insurance Consultant

The United Independent School District is soliciting proposals from qualified consultants to serve as a strategic partner providing expertise, guidance, and administrative support for the District’s employee benefit programs.

School District’s Travel Expenses Called ‘Jaw-Dropping’ Amid District Budget crisis

“Sen. Lindsey Tichenor pressed the superintendent on the district’s credit card statements, calling its travel expenses “jaw-dropping.”

2 Texas Financial Advisers Found Guilty in $80 Million Ponzi Scheme

By Christopher Hoffman – August 19, 2026

SAN ANTONIO – Two Lubbock financial advisers have been found guilty of running a massive Ponzi scheme that federal officials say took in about $80 million from investors, leaving roughly 500 victims with millions of dollars in losses.

Crystal City ISD’s New Health Plan Won’t Survive The Light of Day

At their August 19 board meeting trustees of the Crystal City Independent School District awarded the district health plan to Curative Insurance Company effective October 1.

Is Your Premium Only Cafeteria Plan Compliant?

ATTENTION PLAN SPONSORS: There’s not too many compliant POP Cafeteria Plans out there. The good news is we haven’t seen any badge heavy, gun toting Cafeteria Plan police raiding worksites either. But it’s always good to err on the side of caution so take this as an unsolicited Public Service Announcement intended to keep your butt out of trouble.

90 Degree Benefits GP90 Plan

Discover how pairing a high-deductible health plan with a GAP90 plan can deliver significant savings for employers without sacrificing value.

Brownsville ISD To Entertain Presentations Even Though Top Ranked Vendor Has Been Decided

Could 50 People Be Wrong………………………? All vendors except the anointed one stubbornly cling to hope ……..“It ain’t over until it’s over…………..”

August 18, 2026 at 6:30 PM – Watch Employee Benefits, Insurance and Risk Management Committee Meeting Live………………

Could this be a case of Musical Chairs? Will United HealthCare keep the account or will Blue Cross get it back? Or…….. as they are coming around the corner here they come………. will Dark Horse Curative Insurance Company come from behind for the win? Fifty insurance committee members know the answer. Can they keep a secret?

Why Healthcare’s Future is Direct

By Manny Pastreich, President, 32BJ SEIU and Nick Stefanizzi, CEO, Northwell DirectPosted on May 14, 2026

American healthcare is dynamic and lifesaving – while also becoming unattainable for too many Americans at a price they can afford. For decades, the standard response to rising costs has been to shift costs to workers by raising deductibles, raising premiums, cutting services or shrinking access. The primary payers of American healthcare, employers and workers, now face a staggering $18,500 per employee cost.

Sangamo Therapeutics, Inc.

Sangamo Therapeutics, Inc. is a clinical-stage biotechnology company headquartered in Brisbane, California, that specializes in the development of genomic therapies based on its proprietary zinc finger nuclease (ZFN) technology.