The Math Behind Stop Loss Renewals

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”

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?