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Brownsville Independent School District Seeks TPA Services

Texas Risk Pool Seeks Health Insurance Consultant / Plan Manager

Established in 1999 the South Texas Health Cooperative (STHC), a self-insured risk pool for Texas public school districts, is seeking a health insurance consultant / plan manager.

Aldeen’s Sunday Morning Bathroom Read – “Shark Tank Edition”

How a Texas couple is getting rich off out-of-network medical bills.

Benefits Cooperatives

A larger risk pool helps generate more competitive premiums and offers stability with longer rate guarantees.

Does Your Health and Welfare Plan Need a Committee?

By Katrina Veldkamp – SOURCE: Boutwell Fay

As employer-sponsored health and welfare plans grow more complex, transparency rules abound, new health and welfare plan fee disclosure rules take effect, and class action lawsuits increase (see our recent blog posts regarding voluntary benefits litigation and tobacco cessation program litigation), the need for structured oversight becomes critical. While ERISA doesn’t mandate fiduciary committees for these plans, forming one may be a smart move for plan sponsors.

Medicare For All Is Only One Election Away

All it takes is removal of the 65-year waiting period

The Real Reason Consultants Are Hired

Most of the time, you don’t hire consultants for insight. You hire them to borrow courage you refuse to grow.

Developing a Computable Payer-Provider Contract

“With over 1,000 health insurance carriers offering 318,000 distinct health plan products in the U.S. market………..Each carrier develops its own contract terms such as payment schedules, documentation standards, and prior authorization processes. They can market multiple types of products, HMOs, PPOs, high-deductible health plans, and each plan can have their own set of in-network providers. The complexity of this process contributes to the high billing-related costs in the U.S. market.“

Your Health Plan Has an AI Problem You Don’t Know About

A growing number of employers have restructured their health benefits around independent third-party administrators and reference-based pricing. These models decouple reimbursement from hospital chargemaster rates, effectively removing the mechanism AI billing tools exploit.

Fannie and Freddie Ease Insurance Rules

Lower insurance costs give new homebuyers more confidence they can afford a mortgage

Medicare Premiums Could Double Over The Next Decade, Wrecking Retirement Budgets

“Medicare is a Premium Paying Policy that eventually morphs into a Claim Paying Policy. If you die first you can’t collect later.” – Bill Rusteberg

Aetna $117+ Million False Claims Act Settlement Warning To ERISA Plan Sponsors & Fiduciaries

SOURCE: slphrbenefitsupdate.com

“These and other payer-focused investigations, prosecutions and settlements alert employer and union sponsored health plans, their sponsors and fiduciaries of the advisability of using prudent processes to verify the compliance of their health insurance vendors or the accuracy of their charges or other data to comply with the Employee Retirement Income Security Act (“ERISA”) and protect themselves and their plans from other avoidable costs and liabilities.”

The Risks of Level-Funded Health Plans

This article provides more reasons why employers want out of the health insurance business – RiskManagers

UnitedHealthcare Outperforms Market Benchmarks in Total Cost of Care

New third-party analysis finds that UnitedHealthcare delivered a more than 11% lower total cost of care compared to national benchmarks.

Compare Malpractice Tail Coverage Carriers in Your State & Save $1,000s

SOURCE: Malpractice Tail Coverage

Optional Extended Reporting Period Coverage, more commonly known as Malpractice Insurance Tail Coverage, is an insurance product purchased so that liability coverage extends beyond the end of the policy period of your claims-made medical malpractice insurance coverage.

Two Hospital Town Competes For Reference Based Pricing Business

This is what happens when Reference Based Pricing gains market share in a geographic area like the Lower Rio Grande Valley.

Imagine! Killing Two Birds With One Stone Event

Det. Quinn Says “Every Day Is St. Patrick’s Day!

Detective Quinn says “Every day is St. Patrick’s Day!“

Strait of Hormuz Standoff Puts Supply of America’s Generic Drug Prescriptions At Risk

By Kevin Williams

Nearly half of U.S. generic prescriptions originate in India, which relies on the Strait of Hormuz for the arrival of key inputs in drug manufacturing including petroleum-based materials, and for shipping finished medicines to the U.S.
People should not be worried about their medications yet, including high-volume ones for diabetes and hypertension, statins and antibiotics, as most medical distributors keep a 30- to 60-day supply on hand to withstand disruptions.
President Donald Trump is pressing other nations including NATO allies and China to help protect ships using the vital global marine traffic route. The risks from higher oil prices, and potential for drug shortages and delays, get more real every day.

Primary Care Doctors Struggle To Make Ends Meet

9 Problems Plan Sponsors Have With Their PBMs

By Bryce “Dick” Platt

Maritime Insurers Cancel War Risk Cover in Gulf as Iran Conflict Disrupts Shipping

“Freight rates are volatile amid the fresh instability in the Middle East, with most tankers now avoiding the strait of Hormuz as attacks and insurance cancellations make the area increasingly unsafe.”

Insurance rates could go up by 50% to 100%, or even more, from 0.25% to 0.5% or 1% of the value of the insured asset……………….terminal container rates for Shanghai to Jebel Ali in Dubai, the largest port in the Middle East, rose from $1,800 for a 40ft container on Saturday to about $3,700 on Monday, according to the online shipping marketplace

Yes, You Can Save 35% or More When You Buy Healthcare Direct (i.e. not through an insurance network)

By Dean Jargo

That’s the financial benefit to employer health plan sponsors. Now let’s review all the benefits for patients (your employees and dependents).

San Antonio TPA Simplifies HR Processes

Your Complete Benefits Administration Partner

Creative Benefit Administrators provides comprehensive third-party administration services, managing your employee benefits with expertise and innovation.

Eli Lilly Bypasses PBMs – Wants to Incentivize More Employers to Cover GLP-1s

Lilly will offer Zepbound, an injectable GLP-1 medication, at a price of $449 per month through a platform called Lilly Connect.

Balance Billing & Provider Push Back

Adam Russo of the Phia Group explains balance billing strategies

Benchmarking Claims Off Medicaid Fee Schedule

By Bill Rusteberg

There’s more than one way to skin a cat……………..

Reference Based Pricing plans typically benchmark claims against the Medicare fee schedule. Why not benchmark off the Medicaid fee schedule too?

Actuarial Warfare: How Seven Insurance Letters Closed the World’s Most Critical Chokepoint and Why Markets Are Mispricing Duration by 300%

London treaty reinsurers, confronting unlimited tail coverage, pull capacity………….

Allied National’s Solution For Tight Budgeted Employers Seeking Relief From Punishing Govt. Mandates

A Dental Plan That Beats A Poke In The Eye

Brownsville ISD Considers Early Termination of TPA Agreement

By Molly Mulebriar

The Brownsville ISD has a history of suing their TPA going back years. Pilot Life Insurance Company, Group & Pension Administrators, HealthSmart………….Will United HealthCare be next?

The Growth of Claims Audits

Written by Tim Rieger, Vice President, Sales, Consulting & Education

A growing trend among self-funded medical plans is the increased focus on claims audits. Unlike dependent audits, claims audits are more comprehensive and time-consuming. Employers are increasingly recognizing their fiduciary duty to act in their employees’ best interests, making claims audits an essential part of meeting these responsibilities.

5 Best Workers Compensation Insurance (2026)

SOURCE: Best Business Insurance Companies of 2026

Compare the leading workers compensation insurance providers and agencies of 2026. We reviewed and ranked based on ease of the policy purchasing process, industry accreditations, customer service capabilities, and past customer reviews.

A Common and Costly Oversight: The Importance of a Written Section 125 Plan

A Common and Costly Oversight: The Importance of a Written Section 125 Plan

The Price of Babyhood In Carizzo Springs, Texas

SOURCE: Dimmit Regional Hospital

Blue Cross believes babies are worth more while United HealthCare believes they’re worth less and mothers don’t care because their babies are priceless………….

The Story Behind ‘Lunch Atop A Skyscraper

“Lunch Atop A Skyscraper” captured 11 workers lunching amid construction of New York’s Rockefeller Center on September 20, 1932 — but there’s much more to the story.

For nearly a century, the iconic photograph “Lunch Atop A Skyscraper” has been uniquely evocative of everything from New York City to the Great Depression to America itself. The photo features 11 construction workers casually having lunch while dangling 850 feet above the Big Apple one September day in 1932. But while its imagery is legendary, few know the remarkable story behind it.

Sturgis, Michigan Has 10,000 Residents

By Dutch Rojas – Visit my website

Sturgis, Michigan has 10,000 residents. One company based there billed $826 million in Medicaid personal care services between 2018 and 2024.

For context: to bill $826 million in 15-minute increments at Medicaid rates, you would need to document and submit claims for a number of service hours that, divided by the local population, implies every man, woman, and child in Sturgis received personal care assistance for roughly 2.3 hours per day, every day, for six years.

Texas Penal Code §32.45 — Misapplication of Fiduciary Property

A person commits an offense if he intentionally, knowingly, or recklessly misapplies property he holds as a fiduciary or property of a financial institution in a manner that involves substantial risk of loss to the owner of the property or to a person for whose benefit the property is held.

Aldeen’s Sunday Morning Bathroom Read – The Oregan Potato Company Caper

“The Oregon Potato Company Caper exposes, once again, the nasty underworld of health insurance brokerage” – Bill Rusteberg

GoodRx to Expand Employer-Sponsored Access to Zepbound® KwikPen®

SOURCE: GoodRx – Mar. 6, 2026

GoodRx Employer Direct enables self-insured employers to subsidize the $449 Lilly Employer Connect medication price for Zepbound KwikPen to reduce employee out-of-pocket costs

Hospital Financial Statements, Clinical, and Quality Metrics

Analyze financial statements and clinical metrics of every hospital in the U.S. Review balance sheets, debts and ratios, cost centers, and other financial data. Look up hospital inpatient surgeries, ER visits, average daily censuses, total acute days, and other clinical information.

Health Insurance Costs by U.S. State in 2026

Health insurance costs are rising across the United States in 2026, as enhanced Affordable Care Act (ACA) subsidies expire and insurers raise premiums to keep up with higher healthcare costs.

This graphic shows the average health insurance cost on the ACA marketplace in 2026, based on data from ValuePenguin.

Lilly Lowers Price of Zepbound®

*Regular prices (per month) when not purchased via the Zepbound Self-Pay Journey Program: $599 for 7.5 mg, $699 for 10 mg, $849 for 12.5 mg, $1,049 for 15 mg.

Lilly continues efforts to expand access for people living with obesity by lowering the price of Zepbound single-dose vials

Growing Number of Legacy Health Insurance Brokers Hate The Business

A dying breed of yesterday wonders hoping to stay relevant……….

By Bill Rusteberg

Ask just about any legacy health insurance broker if they like what they do and you will be hard pressed to find one who does. But few will admit it. It’s not cool.

The Secret To ICHRAs

“The standard broad Exchange/IFP network has prices roughly 50% below the broad PPO.”

Curative Insurance Company

In this 11 minute video by Fred, co-founder of Austin based Curative Insurance Company, discloses the company’s secret sauce to control rising health care costs and it’s the opposite of what you would expect.

Trump says US to provide insurance for Persian Gulf maritime trade

SOURCE: IRAN International

President Donald Trump said on Tuesday he had ordered the United States Development Finance Corporation to provide political risk insurance and guarantees for maritime trade traveling through the Persian Gulf.

Dr. Mandrake Curvy Is A Litte Strange

Patient talks about his in-network primary care physician who employs unusual healing methods for the sniffles…………….

Aldeen’s Sunday Morning Bathroom Read (“Send Lawyers, Guns and Money”)

The Barbarians are at the gate with unbridled avarice ready to plunder and pillage.

By Doug Aldeen

Anthem alleges in a recent lawsuit that providers and their third-party biller ( HaloMD) are abusing the No Surprises Act arbitration process to receive higher out-of-network payments in violation of the federal Racketeer Influenced and Corrupt Organizations (“RICO”) Act, the Employee Retirement Income Security Act, and California’s Unfair Competition Law, among other legal requirements.

Reference Based Pricing Spreads Happiness Across The USA

Critical Thinking Exercise Sets Aging Hospital Administrators On Fire

By Bill Rusteberg

This is a must read for hospital administrators over the age of 50 whose diminishing critical thinking skills have skewed reality into fiction at the expense of common sense, reason and logic.

What’s Your Data Worth?

By Bill Rusteberg

Selling information is big business. Take hospital pricing for example. Government diktats mandate hospitals must provide pricing transparency in the form of “Machine Readable Files.”

Price Transparency Is Here

Stop Negotiating. Bring the Facts.

Understand every contracted rate and claim in your market. Level the playing field and turn negotiations into partnerships

Buy Workers Compensation Insurance Online In 5 Minutes

Save up to 20% on your business insurance. Get a quote and get covered online in minutes.

A Third of Employers Can’t Access Medical Claims Data from Vendors, Survey Finds

Many employers are struggling to access their medical claims data from vendors. However, those who do have access are more likely to implement strategies to combat healthcare costs.

Plan Sponsors Beware! Dependent Coverage Is Your Fifth Column

By Bill Rusteberg

There exists among almost every group health insurance plan a Fifth Column, a small group of insiders whose quiet activities work against the principal of the greatest good for the greatest number.

Is Your Group Plan Affordable?

Want to know if the government thinks your group health insurance is affordable or have you figured that out yourself? Has your family coverage cost become like a second mortgage?

Largest Risk Pool In Texas Covers 4.2 Million Texans

58% of risk pool members pay less than $10 per month……………

Novo Nordisk to slash Ozempic and Wegovy list prices by up to 50% for 2027

Battling to regain its market share over rival Eli Lilly, Novo Nordisk announced Tuesday that it will reduce the list prices of its popular weight loss drug Wegovy and diabetes drugs Ozempic and Rybelsus by up to half starting in 2027.

Canada is Killing People in Assisted Suicide the Same Day They Request It

International | Right to Life UK | Feb 20, 2026 | 2:53PM | Ottawa, Canada

People in Canada are having their lives ended by assisted dying on the same day that requests are made, adding to fears that wrongful deaths may be occurring.

THE IDR BLUES

By Craid Gottwalls

The No Surprises Act was designed to protect patients from unexpected medical bills. That is a noble goal. The mechanism created to settle those out-of-network claims, known as Independent Dispute Resolution, is having a very different effect. It has become an inflationary engine for the entire healthcare system.

More than 60% of UHC’s Physician Group E/M Contracts Are Below Medicare.

By Josh Nakka | Healthcare Market Intelligence – Visit my website

More than 60% of UHC’s physician group E/M contracts are below Medicare.

80-90% Of Health Plan Members Pay Cash For Health Care

It it’s true 80% to 90% of people never hit their deductible that means they’re paying for 100% of their care……..in cash.

Amazing Alternative To High Cost Group Family Coverage

Is Your Family Health Insurance Too Expensive? Go here & we’ll calculate cost saving options that may stun you…….and government subsidies you may qualify for. “It’s always in your best interest to be aware of quality options”

4.2 million Texans enrolled in ACA Marketplace plans for 2026 with 97% receiving premium tax credits.

Cash Pay Health Plans Made Simple

Hey Doc! What’s your best price? I’ve got cash!…………………..It’s your choice!”

Say Goodbye to ACA Reporting Headaches

Dreading another reporting season? WEX can help.

San Felipe Del Rio ISD Goes from Self-Insured to Fully Insured

“San Felipe Del Rio CISD believes that access to quality health care for its employees and their families is of great importance.”

Aldeen’s Sunday Morning Bathroom Read – NSA Edtion

“Overnight, the government created a $5 billion market, sanctioned employer balance billing (with an 83% success rate for providers) and gave a 3x-4x pay raise to folks subject to the NSA/IDR regulatory framework. The NSA/IDR process is not a way to occasionally resolve reimbursement disputes. It is a business model.”

McAllen ISD Employee Saves $8,796 On Family Health Insurance

By Molly Mulebriar

Jorge is a devoted employee of the McAllen Independent School District in deep South Texas and like many other working Americans he struggles to pay for family health insurance for his wife and two children. The district offers a generous health insurance package but his cost to add his family is a hair above 9.2% of his annual household income. It’s a second mortgage he can’t afford.

Hammurabi, a Division of Xchange Benefits, Unveils AI Platform That Revolutionizes Medical Stop Loss Underwriting

MyHealthGuide Source: Xchange Benefits, 02/18/2026

ARMONK, NY — Hammurabi, a division of accident and health managing general underwriter Xchange Benefits LLC, a subsidiary of Octave Specialty Group, Inc. (NYSE: OSG), has unveiled an artificial intelligence platform that fundamentally transforms how medical stop loss insurance is underwritten, replacing a traditionally labor-intensive process with near-instant risk prediction and pricing accuracy.

The Greatest Homerun Ever: Bill Mazeroski 1960 Walkoff Homerun

Bill Mazeroski dies at 89…………….

Brownsville ISD Employee Saves $7,597 On Family Health Insurance

By Molly Mulebrar

Jorge is a devoted employee of the Brownsville Independent School District in deep South Texas and like many other working Americans he struggles to pay for family health insurance for his wife and two children. The district offers a generous health insurance package but his cost to add his family is a hair above 9.12% of his annual household income. It’s a second mortgage he can’t afford.

Dental: The Coverage Agents Love to Hate (But Shouldn’t)

We get solicitations to sell various insurance products and services every day. Our mailbox receives more than one a day. We enjoy reading the “Pitch” designed to grab attention. You gotta love these marketing efforts. This is the latest……………….and it’s a great “Pitch.”

Medicash

Cash pay health plan strategies in the United States is becoming popular. But did you know the scheme has been in practice for decades across the pond? The English have been decades ahead of us.