Uncategorized – Page 4 – Risk Managers

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!

The Most User-Friendly Comprehensive Fruitful RFP Search Engine

Finding the right bid opportunities has never been easier.

Educator Investigations in Texas

SOURCE: TEA

The Texas Education Agency (TEA) provides public information about educator investigations to help Texans understand how many reports of educator misconduct are received and how those reports are resolved.

Income Based Medicare Part B Cost

By Nick Depke

Most people are ready for Medicare to be confusing. What surprises them is when their income from 2 years ago shows up in the conversation.

The Truth About Public Bidding

“Decisions are often made before the bidding begins, a formality designed to foster the illusion of competitive procurement” – Molly Mulebriar

59-Year-Old Retired Delivery Driver Robbed A Bank For $1 So He Could Get Medical Care In Jail — ‘It Was Worth It. I Had No Other Direction to Go’

By Ivy Grace – August 8, 2025

It wasn’t about the money. It wasn’t about the thrill. It was about getting arrested—on purpose.

U.S. Towns Paid for Teachers and Cops to Use Weight-Loss Drugs. It Broke the Bank

SOURCE: Job Advisor

Cities and towns across the country are scrambling to contain the resulting surge in healthcare costs. Many point directly to the popular weight-loss drugs as a major driver of budget pressure.

Memorial Day 2026

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.

I knew little of my father’s participation in WW2 until after he died. Unlike veterans of today his generation didn’t talk much about it. Their quiet pride was enough, understood by all. The following recounts the Battle of Hatten in which my father was a participant. – Bill Rusteberg

The Psychology of Groupthink and the Dangerous Desire for Consensus

“Groupthink decisions rarely have successful outcomes.”

Insurance committees are often integral to decision making, especially among political subdivisions. The dynamics of groupthink must necessarily be understood.

100 Best Risk Management Blogs to Follow in 2026

The best Risk Management blogs curated and ranked based on multiple factors, including content relevancy, subject expertise, posting frequency, and freshness of content. Blogs with highest credibility within the Risk Management space are ranked higher. This list is updated regularly to ensure it reflects the most active, influential, and valuable Risk Management blogs on the internet today.

35 Of The Dumbest, Most Ridiculous Patients To Ever Enter The ER, And I’m Convinced Healthcare Workers Do NOT Get Paid Enough

Hey, I totally understand the need to see a doctor due to moments of fear for one’s life. But there’s that, and then there are these people.

We Just Lost An RFP. Why?

By Chris Barakat

In 10 years, the most prestigious business schools will be educating the next generation about how we changed healthcare and health insurance in the United States.

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.

Feeding Brokers At The Expense of Starving Ones

By Bill Rusteberg

In 1982, after nine years of corporate servitude, I left the inner sanctums of a large health insurance company and the comfort of receiving a corporate paycheck every two weeks whether I earned it or not.

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.

Cost of Paying Claims

By Bill Rusteberg

Self-funded? Curious about how much it costs to pay a claim? To find out you have to ferret out all the fixed costs. Be aware, some are hidden on the claim side of the ledger.

Don’t Work For A Company That Withholds Your Compensation From You

“Employer health coverage. Its optional. A person is free to decline that coverage and buy cheaper services/products elsewhere. There is no fiduciary injury when a person chooses to overpay. And the person is free Feto ask for higher wages instead of health benefits. Or don’t work for a company that withholds your compensation from you.” – Leon Wisniewski

Free Guide For Medicare Eligible Employees

FROM: Joanne Giardini-Russell – joanne@gmedicareteam.com

Hi there!

Quick one. We launched WorkPast65.com this morning. It’s a free guide that walks Medicare-eligible employees through the working-past-65 rules in plain English. Within hours we had hundreds of downloads. People want this information badly, and most are getting it wrong because the rules genuinely aren’t intuitive.

Why Accepting A Fully Insured Renewal is Financial Negligence

By Jim Farley, J.P. Farley Corporation

There was a time when treating your company’s healthcare plan as an administrative HR function was just mildly inefficient. Today, it is the equivalent of institutional financial negligence.

A Picture Worth 1,000 Words

What is the reason for this?

South Texas Health Cooperative Seeks Insurance Consultant

For more information contact Alex Cespedes – Phone: (956) 797-8310

BCBSTX 2026 Renewal Bonus Schedule

Insurance companies want to retain as much business as possible. Incentivizing brokers is a powerful means to that end.

How Lloyd’s of London Works: A Simple Explanation

By George Shirley

Most people outside of the insurance market have no idea how Lloyd’s of London actually works, so here’s a *very simple* version:

Introductions Are Worth Big Bucks In The Insurance Industry

Earning commissions forever by simply making an introduction beats working for a living………….

Who Really Pays For Healthcare?

By Brian Cotter, MPA HSF

Myth: “When hospitals and providers get paid more, it’s the insurance company footing the bill.”

Reality: For millions of Americans, especially in self-insured health plans, the money paying provider claims comes directly from workers’ premiums and employer benefit funds.

City of McAllen Health Plan Seeks Competitive Bids

City of McAllen – 06-26-S84-432 – EMPLOYEE HEALTH PLAN

No Surprises Act Statistics

By Brian Cotter

No Surprises Act IDR Outcomes – Providers: 86%. Plans: 14%.

Reference Based Pricing Enters The Individual Market

ACA exchange enrollees will now have access to insurance models built around transparency and open access, not networks

Stop Signs

By Bill Rusteberg

There’s a stop sign in Victoria, Texas that commands enforcement to all who approach. So, what else is new? There are hundreds, maybe even thousands of stop signs in Victoria.

Nationwide Access To Diagnostic Imaging

“Longhorn, recognized as the most affordable cash option in the greater Austin area, gave her a price for an MRI of shoulder of $550, which is a good price. Radiology Assist got it for her, at Longhorn, for $285!” – Jody Bright

Lawmakers’ Prescription Data at Risk After Data Breach

Congress’ Office of the Attending Physician informed affected members this week about the hack affecting a key contractor.

By Katherine Tully-McManus05/13/2026, 4:03pm ET

Lawmakers on Capitol Hill were informed this week of a data breach involving the congressional medical office that may have compromised personal information — including their prescription history.

Premise Health

When people are healthier, their organizations can thrive. In a claims-based analysis of 207,000 eligible lives from across 26 organizations, the results were clear: advanced primary care leads to better health and lower healthcare costs. The study methodology was validated by Milliman, an independently recognized actuary.

Chair Frank files Class Action Lawsuit Against Blue Cross Blue Shield

Article Referred by Charles Luke

Chair Frank files class action lawsuit against Blue Cross Blue Shield

The suit, which comes as Rep. Frank leads legislative hearings into health care affordability, alleges Blue Cross misrepresented the actual cost of prescription drugs to the plan while receiving undisclosed rebates and driving up costs

Former Truck Driver Solves Health Care

Health insurance has become a de facto government utility punishing plan sponsors while rewarding insurance and pharmaceutical companies. Those carrying the brunt of punishing government induced burdens are working Americans who have become functionally uninsured and under continuous threat of personal bankruptcy.

Texas Public Schools Posted Their Second Largest Enrollment Decline inthe Past 40 Years

SOURCE:Enrollment Report

Enrollment Declined in 18 of 20 ESC Regions, Hitting Hardest in the Rio Grande Valley, Amarillo and Midland.

Itty Bitty Titty Business

SOURCE: Brian Cotter

Surgeon loves little itty bitty titties…………

The data is there. The savings are real. But nobody is opening the box. Brian Cotter turns payer MRFs and claims data into pricing clarity for self-insured employers, Taft-Hartley funds, benefits consultants, and TPAs. Independently, and benchmarked against Medicare.

Risk Management Since 1973

Business is about solving other people’s problems. Solving the high cost of healthcare giving employers a competitive advantage is ours.

Another ERISA Complaint Targets Voluntary Benefits

SOURCE: PLANSPONSOR

The plaintiffs’ law firm expanded its campaign against employers over supplemental insurance offerings, arguing that workers are overpaying for critical coverage.

Why Are So Many Drivers Suddenly Shopping Their Car Insurance?

“Insurify is one of those things that just makes sense to check. Car insurance rates have gone up a lot recently, and it only takes a few minutes to compare quotes and see if you could save money. The process is simple, and there’s really no downside to seeing what other options are out there”. -Cole, CEO

TRS Board Sets Higher ActiveCare 2026-2027 Rates

Despite a growing number of districts joining the government health plan, enrollment is down due to cost. Coverage on the individual market is often a cheaper alternative for TRS ActiveCare members.

Hospital Terminates Blue Cross Contract

“The burdensome payment policies, denials and reimbursement delays for patient care have made it financially and operationally unsustainable for the hospital to continue participation in these plans……”

Aldeen’s Sunday Morning Bathroom Read

“The breast surgeon was awarded $440,000 for performing a routine breast reduction for which he has historically been paid and accepted between approximately $6,000 to $30,000…………….”

Mary Anne

By Glenn Beck

I want to tell you the story of a young woman who you have probably never heard of. Her name is Mary Anne. She was born on a remote island in Scotland, where life was harsh and unforgiving.

Healthcare Contract Negotiation That Maximizes Your Reimbursement

Full Visibility Into Your Competitors’ Rates

Visualize rates relative to your competition. Know your position in the market today – for any payer.

Unrivaled dataset that includes 95% of commercial coverage
Actual, negotiated allowable amounts, not claims-based estimates
Compare rates to other providers in your state and specialty
Updated monthly with newly published data

Rachel Strauss

Rachel Strauss – Visit my website

His inhaler went from $70 to $500. Five days later, he was gone. Healthcare transparency isn’t political. It’s personal.

The Myth Of A $20 TPA

May 8, 2026

By Jim Farley | CEO / Owner at J.P.Farley | Third-Party Administrator | Since 1979

Why the “Cheapest” Health Plan on the Spreadsheet is Costing You a Fortune.

If a TPA tells you they only need $20 per employee per month (PEPM) to run your plan, you need to ask yourself a very simple question: How are they staying in business?

Monoline HNOA Program

We offer a monoline HNOA program on an excess basis. Can sit over personal auto, contractor auto, existing HNOA, or rental coverage.

TRS ActiveCare – Seven Reasons Districts Opt Out

LIFE SETTLEMENTS

Helping you get the most value out of your life insurance policy.

Our goal is to maximize your policy value and obtain the highest bids available in the life settlement market. We do this by using our underwriting and product expertise to help you reach a higher policy valuation. This process allows us to help you negotiate the best options for you and your family.