admin – Page 4 – Risk Managers

Pharmacy Without The Middleman

PBM AWP Price – $2,500…….CASH PRICE = $18

How Much Time Did Your Doctor Spend With You?

Time Is Money But Patients Don’t Get Any For Theirs……………….

By Bill Rusteberg

You need to see your doctor. It takes days and weeks to see one (they are really busy these days).

Indiana Promotes ICHRA

Indiana’s ICHRA tax credit gifts small businesses $400 per employee in the first year and $200 in the second to subsidize ICHRAs.

You Don’t Need A Consultant When You’re Fully Insured

By Bill Rusteberg

You don’t need a consultant when you fully-insure with a BUCA. You are wasting your money if you do.

Aldeen’s Sunday Morning Bathroom Read – Father’s Day Edition

“Modern Healthcare recently reported that HaloMD is the leading claims initiator in No Surprises Act’s Independent Dispute Resolution system, which fielded 6.3 million out-of-network billing cases from its inception in 2022 through last month, far surpassing expectations. In the second quarter of last year, for instance, HaloMD was involved in 22% of IDR cases, according to a study the Georgetown University Center on Health Insurance Reform released in March.

The Hidden Ways Brokers Earn Money in Self‑Funded Plans

By Bill Rusteberg

Would you like to know how a broker earned $614,000 on a Texas school district without anyone knowing about it?

Joe Makes How Much!

“Don’t look at Premium as compensation, look at the claims generated by that member”

Deacon Opines

By Chris Deacon – Speaker. Thought Leader. Truth Teller. Disruptor. *All Content non-AI Generated*

I have to give Cigna Healthcare credit. This may be the most transparent explanation of why employers need transparency.

In a few short paragraphs, Cigna openly acknowledges that it may receive revenue from vendors it selects, vendors it steers business toward, formulary arrangements, out-of-network negotiations, subrogation recoveries, and affiliated companies providing services to employer health plans.

Valley Risk Consulting Inc. On Schedule To Win South Texas Health Coop Consulting Contract

At their June 25, 2026 special meeting the La Feria Independent School District trustees will consider authorizing the Superintendent to take the necessary steps to replace the South Texas Health Coop’s current insurance consultant with Valley Risk Consulting of McAllen, Texas.

Raymondville ISD Health Clinic Set To Close Its Doors

By Gabriela Gonzalez Jun 18, 2026 SOURCE: Valley Central

HARLINGEN, Texas (ValleyCentral) — The Raymondville Independent School District Health Clinic is set to close its doors in July.

Ayatollah Re – Insurance You Can’t Refuse

Iran floats ‘insurance fees’ as it asserts control over Hormuz

“At present, this insurance is provided free of charge to the vessel owner, with all expenses covered by the Islamic Republic of Iran….”

Find The Most Affordable Plan For You Here…………

1 out of 3 people pay under $30 per month.

Free lookup without providing your name or contact information. Find benefits and rates in seconds. Compare to what you have now.

You may find big savings covering your family members here rather than through your employer’s plan

The Fickle World of Payroll Deduction Voluntary Benefits

What percentage of employees would drop voluntary benefits if payroll deduction was replaced with direct pay through bank draft or credit/debit card?

You’re Making How Much!

“You’re making how much!” said the new CFO. “That’s more than what I make!”

PPOs Powered By Lemminghood

CREDIT: Craig Gottwal

“The only thing a PPO guarantees is the promise of no balance billing” – Bill Rusteberg

State Farm Reduces Base Compensation For 19,000 Agents

“20 years ago, individuals were told, ‘Hey come in here, build a $3-5 million book of business. You sit on it the rest of your career. You have an annuity.’ It’s not that anymore. With time, commissions are going to go lower and lower. There is not a doubt. With time, carriers are going to implement AI and automate as many things as possible……..”

Tenet Gets Top Dollar Because They Can………….

By Josh Nakka – Co-Founder @ PriceMedic | Healthcare Market Intelligence

Tenet Healthcare’s surgery centers are getting reimbursed at 2x+ the local market median in nearly every state they operate in.

Texas School Districts – One Statute Says YES, Another Says NO

Sec. 1501.009 of the TEXAS INSURANCE CODE stipulates an independent school district may elect to participate as a small employer without regard to the number of employees in the district. Is it a Dead Letter statute?

Reference Based Pricing Without All The Middlemen

By Bill Rusteberg

Reference based pricing schemes employ all kinds of middlemen to keep noise down and make member experience as easy and pleasant as possible. Adding all the layers needed to accomplish that proves the cost of convenience is high at the expense of reduced provider reimbursement.

What If An ICHRA Is Deemed Unaffordable……….

By Brad O’Neill – The Wizard of ICHRA & Choice Benefits

What if the employee is financially better off declining the ICHRA?

The Affordable Care Act Embraces Reference Based Pricing

Hospital Administrator Reacts

SOURCE: KFF NEWS

Starting in 2028, some Affordable Care Act consumers may be able to pick plans that don’t have dedicated networks of doctors and hospitals, which patients use to qualify for negotiated in-network payment rates.

The Upside Down Economics of American Health Care

By Bill Rusteberg

The United States is the only country on the planet where medical caregivers bill patients knowing they will never be paid in full. Every bill is discounted and often more than once.

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen – ERISA Healthcare Attorney and Fractional General Counsel•

Memorial Hermann (“MH”) in Houston recently implemented a “Reference Based Pricing and Limited Benefit Plan Discount Policy” that entitles these types of plans to discounts between 35% and 45% contingent upon the location of the facility.

Apaly Offers Same Day or Next Day Primary Care

SOURCE: Apaly

Apaly has created an online platform that brings the employees and families of regional and nationwide employers, together with phenomenal advanced primary care (APC) providers.

Boudreaux Wilson III Joins RiskManager.us

Mr. Wilson joins staff at RiskManagers.us.

An Offer You Can’t Refuse

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

MedSave Management is in the business of building Medicare based provider networks for self-funded plan sponsors.

The ICHRA Industry Has A Math Problem

By Brad O’Neill – The Wizard of ICHRA & Choice Benefits

I think the ICHRA industry has a math problem. A 100-life employer spends $1,000,000 annually on health insurance. An ICHRA analysis shows 15% savings, or $150,000 per year.

Tired Yet? Ready To Do Something Different?

Health Insurance Broker Presents Group Health Insurance Renewal

Are you ready to get out of the health insurance business? Timing could never be better.

Compare the Lowest Cost Bronze Plans on the Individual and Small Group ACA Markets by County – 2026*

ICHRA Insights, Powered by Ideon

Explore which states and counties are primed for ICHRA adoption with our interactive annual maps

Here’s A Listing of San Antonio Providers Who Take RBP Patients

San Antonio is a mature Reference Based Pricing market. It all started in 2007 when a local employer found there was a better way to finance health care.

The Truth About Group Health Insurance

Status Quo Health Insurance Broker Leading His Clients

“What’s that ahead!” says one lemming to another, “No one told us about that.“ For the first time they see something other than the ass in front of them.

Brownsville Texas Native Makes Fortune In Insurance Business

Former high school coach makes fortune in the insurance industry……………………….

How Much Are You Really Paying Your Broker?

By Richard Polak

When I was working at an insurance carrier, I saw how override commissions really work.

Brad O’Neill – The Wizard of ICHRA & Choice Benefits

The future of employee benefits isn’t just about offering more benefits—it’s about making them easier to access, understand, and use.

The ICHRA Shop developed www.ChoiceBenefits.ai, we’ve built a platform designed to simplify benefits administration while giving employers and employees access to a broad ecosystem of solutions that support physical health, financial wellness, and overall employee experience.

The Five Stages Of A Health Insurance Renewal

Credit – Craig Gottwals

Check Out Your Hospital’s Pricing, Costs, and Quality Metrics Here

Sage Transparency is a free, web-based tool providing unbiased, comprehensive data on U.S. hospital, ambulatory surgery center, and physician-administered medication prices and quality.

Are Hospitals Here To Protect Communities Or Their Profits?

By Julie Wasserman

Reference Based Pricing is gaining traction, but with it, we are seeing a handful of hospitals pushing back by refusing access. Ironically, some of the most recognizable non-for-profits are leading the charge against RPB.

It’s………………..

Why would any employer embrace another health plan that doesn’t lower cost, has status quo benefits and promises double digit rate increases year after year?

Nish Built Something Providers Hate

Your TPA doesn’t audit for abuse………..Solomon does.

If you’re self-insured, you’re not just paying for your employees’ care. You’re funding every billing error, every upcoded procedure, and every duplicate charge your plan administrator didn’t catch. Solomon finds what they missed, systematically, across your entire claims history.

How To Analyze A PBM Contract In Less Time Than You Can Say “What Took So Long”

PLAN SPONSOR: Dear ChatGPT, can you analyze a PBM contract?

Anthem’s General Counsel just fired off a cease-and-desist letter to one of the most innovative brokers in the industry. They are pissed.

Eric Dreyfus introduced a cool AI tool that analyzes PBM contracts. It worked. And Anthem is not very happy…………….

The Future of Employee Benefits Starts with Choice

Choice Benefits combines health coverage, voluntary benefits, and flexible reimbursement strategies in one platform.

The El Paso Independent School District’s Self-Funded Health Plan Implodes……………Again

The El Paso ISD self-funded health plan is in trouble again. The plan relies on the belief that doing nothing is better than doing something. Instead, they continue to place blind hope on the CIGNA network of “preferred” providers because they believe PPO networks save money when everyone in the industry knows the opposite is true.

Arlington ISD To Open Onsite Clinic

Teachers React To The News

Arlington ISD is planning to offer a third-party clinic network conveniently located within the district, anticipated to open in the spring of 2027.

Medicare Tinkers With GLP-1 Drugs

Starting July 1, 2026, Medicare will begin a short-term demonstration, called the Medicare GLP-1 Bridge, that will provide eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs.

Medicare Brokerage Brings BIG BUCKS

By Kashif Baloch – President @ Hello Support Network — Insurance Marketing — Medicare | ACA | Auto | FE | Home Services

CMS has officially released the 2027 Agent & Broker compensation rates for Medicare Advantage and Part D plans.

Cigna Drops Coverage of GLP-1 Obesity Drugs for Its Own Employees

FILE PHOTO: A combination image shows an injection pen of Zepbound, Eli Lilly’s weight loss drug, and boxes of Wegovy, made by Novo Nordisk. REUTERS/Hollie Adams/Brendan McDermid/Combination/File Photo

Reuters – June 2, 2026 -mBy Amina Niasse

NEW YORK, June 2 (Reuters) – Health insurer Cigna ⁠will ⁠stop covering GLP-1 weight-loss drugs ⁠including Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound in its employee health plan effective July 1, according to materials viewed by Reuters on Tuesday.

ICHRA: Are Brokers Driving Market Demand Or Reacting To It?

By Bill Rusteberg

No one can argue ICHRA market share is growing driven by market demand. Statistics prove it. No question about it. There’s a clear winner in that debate.

If Healthcare Is So Inefficient, Who Is Actually Making Money?

“If you’re saving companies millions, how does everyone still make money?”

The Power of Free Market Choice

By Bill Rusteberg

UMC Health System in Lubbock, Texas has recently refused to accept an assignment of benefits offered by a prospective patient in need of care because the hospital wanted a higher reimbursement than what the hospital accepts from Medicare, the largest government health plan universally accepted throughout the United States.

Competition Among Hospitals is Rare Except In Harlingen, Texas

This is what can happen when Reference Based Pricing plans capture market share…………….

By Bill Rusteberg

Valley Baptist hospital in Harlingen, Texas has been accepting Reference Based Pricing plan patients for many years. Balance billing has been few and far between. Area Reference Based Pricing plans have been paying 120% of Medicare and in some instances less than that.

Allowed Amount Is Not The Same As Paid Amount

By Ralph Weber

The RAND study almost, kind of, sort of ‘says’ hospitals get paid 254% of Medicare by commercial plans. But does it really? If you read it very carefully, you’ll find something else.

TX ACA Market Directory · 2026 Coverage

Metropolitan areas have the best rates and more choices. Rural areas have generally higher rates and less choices.

Compare statistics on health insurance plans across Texas – Houston, Austin, Dallas, and every Texas marketplace region.

New Rule Requires Medicaid Beneficiaries To Work

Beneficiaries must work or volunteer at least 80 hours per month, attend school at least part-time, or participate in job training.

Core Benefits Is A Broker’s Broker

Core Benefits is a non-captive agency that is contracted for all lines of business: Health, Supplemental, Medicare, and Life Insurance. At Core, not only will you have access to top tier Carrier contracts, but you will also receive 100% of the commissions and will be eligible for every carrier contests/bonus programs. With most carriers, the agent is set up to be paid directly by the Carrier.*

Sorry, We Don’t Take That Insurance

By Bill Rusteberg

It’s all about money. Some want more, some take less. Or is it?

Baskin & Robbins

“it’s too complicated. Our employees don’t have the mental capacity to decide which is best for them. Thiry one options for Christ sake! They need help navigating choices, they can’t do that alone!” says the nice lady in HR.

Breakthrough Pancreatic Cancer Treatment Doubles Survival Time

After new drug’s ‘unprecedented’ results for pancreatic cancer, doctors look at other uses

The experimental drug daraxonrasib, which doubled survival time in patients with advanced pancreatic cancer, may also prove effective for lung, colon and ovarian cancers.

Don’t Let Your Life Insurance Policy Lapse – Sell It

If you are planning to discontinue a term policy at the end of the level term period, or want to surrender an existing whole life or UL policy, it’s important you understand all your options before walking away.

Got a Hospital Bill You Can’t Pay?

Most hospitals are required to have programs that discount or completely forgive bills for some patients. But they don’t make it easy. We’re a nonprofit organization and we help you apply. It’s quick, easy, and free.

Quick Facts About Private Health Insurance in Texas

SOURCE: Apollo Insurance

Texas uses the federal Marketplace as its ACA Exchange.
Open Enrollment for On-Exchange plans will be from November 1 – December 15.
Off-Exchange plans offer year-round enrollment.
Plans from 21 different carriers.

John’s Amazing Life Saving Story Gives Hope To Millions

89% of Employees Say Their ICHRA Coverage Is Better Than Their Prior Group Plan

“I hate my employer’s one size fits all health plan! I want an ICHRA!”

Did Texas Gift Supplemental Funding to Keep TRS ActiveCare Solvent or To Mitigate Rate Increases?

The perception among many is TRS ActiveCare is going broke and state supplement funding is the only reason the program remains solvent. But then we hear the opposite from officials in Austin.

Was the purpose of supplemental funding to stave off insolvency or was it designed to lower rate increases? What’s the difference?

Normandy Insurance

Agents, the commission math just got more fun → earn 18% on new business and 25% on accounts over $25K for a limited time.

City of McAllen Seeks Competitive Health Insurance Proposals

The City of McAllen (“Planholder”) is soliciting proposals for Third-Party Administration (TPA) services for its Employee Health Plan, covering eligible participants including active employees, retirees, city officials, affiliated agency personnel, and their dependents.

So You Think You’re Getting 100% of The Rebates? Think Again………

By Ginny Crisp

Your PBM passes through 100% of manufacturer rebates. The rebate aggregator does not have to.

The No Surprises Act Just Got Turbocharged………….

JUST ANNOUNCED: The federal government just made moving disputes through the No Surprises Act IDR process easier, faster, and cheaper. For providers, that’s good news. For self-funded employers and health plans, it’s highly concerning

It’s A Sellers’ Market In A One Hospital Town

“We are increasingly concerned that Covenant is using the threat of interrupted treatment and balance billing to secure reimbursement rates that are unreasonable and unsustainable”

How the Curative Cash Card Streamlines Payment for Providers and Expands Access to Care

Curative is modernizing health care with a new approach: the Curative Cash Card. It’s designed to streamline payments, support patient access and give providers a fast, predictable way to get paid—no claims process required.

The World’s Longest Waiting Period

“Remove the waiting period! A 65 year waiting period has to be the longest waiting period for health insurance ever devised by man.” says Joe Sixpack

Whatever Happened To Mark, Sam, Arnie, Will, Michael and Joshua?

Broker admits paying for inside info on San Antonio school districts

Nov 1, 2016 · An insurance broker admitted Tuesday that he bribed a consultant for area school districts for inside information to help win insurance contracts.

Hospital Data Reveals Significant Delta Between Commercial & Medicare Pricing

By Craig Gottwals – Attorney & RBP Expert

In looking at the 15 largest hospital systems in the U.S., the data reveals a persistent, significant delta between commercial and Medicare pricing, with the average commercial price hitting 282% of the Medicare rate. This is not a slight variation; select systems are charging up to a massive 410% of what Medicare pays for equivalent services. This pricing has profound financial consequences for large-group plans.

Marpai Inc. Announces Unprecedented Growth with 192,000 New Estimated Member Lives

Stock Price 5/27/2026

“We view this is a watershed moment for Marpai,” said Damien Lamendola, Chief Executive Officer of Marpai. “Securing 192,000 estimated new member lives validates the power of our integrated TPA and MarpaiRx PBM models.

Farley Opines On Fully Insured Renewals

By James Farley – President at J.P. Farley Corporation | TPA

MOST fully insured plans receive double-digit increases even when the insurance company makes a significant profit from it. AND they’ll “competently” explain to you why you should be grateful for those double-digits, too!