Category: Uncategorized

How a Cash-Pay, Reimbursement Model Works (And Why It Can Save You Thousands)

Start Health is a reimbursement policy (Indemnity Plan), not traditional insurance. We reimburse fixed amounts based on your care, which gives you the freedom to choose providers and control costs. As the only reimbursement plan that’s designed to be HSA-eligible, you can also pay tax-free with your Start HSA Card, combining flexibility, transparency, and savings.

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Proposed PBM Fee Disclosure Regulations – A Major Gamechanger

The DOL’s proposed regulations establish new disclosure and audit requirements for “covered service providers” that enter into contracts or arrangements with self-insured group health plans and reasonably expect to receive $1,000 or more in compensation in connection with providing pharmacy benefit management services or providing advice, recommendations, or referrals regarding the provision of such services.

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Drop The Middlemen – Choose Direct

SOURCE: Directhealthplan.com

Direct Health Plan is a complete solution for self-funded employers in need of an employer health plan.

  • Operates as a stand‑alone plan or integrates seamlessly with multi‑plan offerings; built for your control and flexibility.
  • Serves as a chassis for health systems, DPC/concierge practices, advisors, and the wider health solutions industry, a foundation for innovation. Let’s build.
  • A fully fee‑based model — no shared savings, hidden rebates, or commissions.

Distribution: Direct to employer and select broker partners across the United States.

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Attor­ney Gen­er­al Ken Pax­ton Demands Infor­ma­tion from Blue Cross Blue Shield of Texas and Con­duent as Part of Inves­ti­ga­tion into Largest Data Breach in U.S. History

Article Referred By Lori Ramos

Attorney General Ken Paxton issued Civil Investigative Demands (“CIDs”) to Blue Cross Blue Shield of Texas (“BCBS”) and Conduent Business Services LLC (“Conduent”), demanding documents and information pertinent to the investigation of the Conduent data breach that exposed the sensitive personal data of approximately four million Texans.

Continue reading Attor­ney Gen­er­al Ken Pax­ton Demands Infor­ma­tion from Blue Cross Blue Shield of Texas and Con­duent as Part of Inves­ti­ga­tion into Largest Data Breach in U.S. History

What Traditional Group Insurance Brokers Won’t Tell You

Employer Sponsored Group Dependent Coverage Is No Longer Relevant

“For a lot of families, $15–$25K for dependent coverage isn’t “benefits” anymore — it’s a second mortgage. When ACA marketplace options can deliver compliant coverage with subsidies that drop costs to a few hundred dollars (or less), it’s hard to justify forcing everyone into the group plan just because “that’s how we’ve always done it.”

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Drug Pusher Launches Website

White House Launches Direct-to-Consumer Drug Site TrumpRx. Here’s what to know

Published Thu, Feb 5 2026

KEY POINTS

  • President Donald Trump on Thursday announced the launch of TrumpRx — a direct-to-consumer website that is key to his administration’s efforts to lower prescription drug costs in the U.S. 
  • The site is not selling drugs directly to American patients, but will act as a central hub that points them to drugmakers that are offering discounts on certain products on their own direct-to-consumer sites.
  • It’s still unclear if all patients, particularly those with insurance coverage, will see more cost savings from using that site to buy their medicines.
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340b Prescription Drugs – Safety Net or Margin Expansion Strategy?

“Hospitals already control the claims. Employers already pay full freight. And employers have no negotiating leverage once the claim hits the plan……SwyftScripts does not control prescribing. Hospitals do not control employer savings. And revenue is not driven by utilization expansion, but by reclaiming margin that already exists in the system.”

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Health Care Prices Rise as Role of Private Equity Grows

Illustration by Craig Gottwals – Attorney & RBP Expert

Aggressive billing strategies, remaining out-of-network, exploiting payment disputes to maximize revenue. misuse of the No Surprises Act, with a handful of private equity-backed providers and “IDR middlemen” routinely exploiting the law’s Independent Dispute Resolution (IDR)……

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ERISA Security Bond Is A Requirement For Most Private Sector Plan Sponsors

SOURCE: Surety Bonds Direct

A surety bond is a type of insurance that acts as a financial guarantee that a promise of performance and ethical behavior will be delivered as required by a contract or agreement. In simple terms, a surety bond protects customers or employees from purposeful theft or financial damage.

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Are “Voluntary” Benefit Programs The Next Big Thing In ERISA Litigation?

Joseph C. Faucher
Joseph C. Faucher

In late December 2025, the same law firm that initiated the wave of “excessive fee” 401(k) litigation matters in 2006 (which continues to this day) filed a spate of lawsuits alleging that several large employers (and their benefit consultants) breached their fiduciary duties under ERISA by allowing excessive or unreasonable premiums to be charged to their employees in connection with so-called “voluntary benefit” programs offered by those employers.

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TPA Says It’s Impossible To Reprice Hospital Claims To Medicare

A TPA for a Reference Based Pricing plan was found repricing inpatient hospital claims at a % of billed charges instead using Medicare rates as the claim benchmark. When questioned the TPA sent the following email response:

“It’s impossible to reprice hospital claims to Medicare. Therefore, RBP repricing is approximated by paying a percentage of billed charges.”

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Allstate Benefits Is Now Nationwide

We are excited to share an important update. Effective February 2, 2026, your client’s Allstate Benefits group health plan will join the Nationwide family. This milestone marks the next step of the acquisition previously announced in July 2025. There is no impact to the plan, coverage, service experience, or administration — this is a name change only.

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Switzerland’s Universal “No Single Payer” Health System

By Sheri Mancina M.D.

Switzerland Didn’t “Go Single Payer” when it reformed healthcare. Switzerland has universal healthcare, but it is not a government-run system. There is no national health service. There is no single government insurer. Doctors and hospitals are private. Insurance companies are private.

They separated access from profit. Here’s how the Swiss system actually works — in plain language:

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Most Insured Individuals Use Relatively Little Health Care

The use of health care services — and the spending associated with those services — is far from evenly distributed across the population. It has long been known that a small portion of the population accounts for a disproportionately large share of health care spending, with 20 percent of the population typically accounting for
80 percent of total health care spending.

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How Three Communities Cut Healthcare Costs 20-50% and Redirected Savings Back to Employees

  • When Ashtabula reclaimed healthcare control, they saved $2.4M in year one with just 300 school district employees. That’s $8,000 per employee. The district went from dangerously low reserves to choosing how to spend their dividend: higher pay, better benefits, subsidized healthy food, restored programs.
  • Approximately $450 million annually flows out of Ashtabula County into distant corporate healthcare systems. A tremendous sum for a county of 100,000 people. That extraction weakens everything: wages, schools, economic opportunity, health outcomes.
Continue reading How Three Communities Cut Healthcare Costs 20-50% and Redirected Savings Back to Employees

Understanding IRS Section 501(r): What Employers and Employees Need to Know

Did You Know That 100,000,000 Americans Qualify For Free Care?

SOURCE: Memberly Benefits.

Healthcare costs can feel overwhelming for both individuals and employers. Fortunately, there are federal rules designed to ensure fairness in how nonprofit hospitals bill patients and provide financial assistance. One of the most important is IRS Section 501(r). Here’s a breakdown of what it is, how it works, and why it matters for employees, employers, and plan sponsors.

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Meet Lesli Wood

Lesli Wood – Regional Vice President of Sales for Central/South Texas

She brings over 25 years of experience in the health benefits industry, with a proven track record in sales and account management at organizations such as Allied Benefit Systems and Humana. Her passion for building strong relationships and delivering exceptional service makes her a valuable addition to the Meritain Health Sales Team.

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100 Million People Qualify For Free Care

Meet The Bull

Dr. Bill “The Bull” Hennessey is a physician turned whistleblower who has spent decades exposing the fraud, waste, and abuse that cost Americans billions every year. Nicknamed “The Bull” for his aggressive, no-nonsense style, he has been featured on Dr. Phil, national TV networks, and investigative outlets, bringing hidden industry practices into the light.

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Judi Health Unveils Launch of Advisory Firm, The Judi Group

stethoscope on red background with piggy bank
The Judi Group’s team will conduct “forensic-level” analyses across the vendors a plan sponsor works with to spot and remedy key issues, according to an announcement shared exclusively with Fierce Healthcare. (Kubra Cavus/GettyImages)

By Paige Minemyer  Jan 20, 2026

Capital Rx A.J. Loiacono Employer-Sponsored Health Plan Healthcare Costs

Last fall, transparent pharmacy benefit manager Capital Rx rebranded as Judi Health in a bid to better reflect the breadth of the company’s portfolio.

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