Risk Managers – Page 4 – Thought Leadership on Health Insurance

Model Legislation Mandates Reference Based Pricing For Prescription Drugs

SOURCE: HERE and HERE

Model legislation could apply to state regulated commercial market and self-insured plans…………..

Aging BUCA Representative Lets It Rip

The BUCA World Is Aghast

A riveting video of an aging BUCA rep. is going viral in BUCA boardrooms across the Fruited Plains.

Days & Weeks Followed By 5 Minute Doc Visits Drives DPC Market Demand

Primary Care Personnel (PCP) Slave At The Chocolate Factory

By Bill Rusteberg

Traditional fee-for-service office visits these days reminds one of the iconic and chaotic Chocolate Factory Scene from “I Love Lucy.” High speed conveyor belt care, meeting with patients five minutes at a time followed by a prescription coupled with time consuming after encounter recordkeeping is chaotic and inefficient.

4-Year-Old Wants To Become An Actuary When He Grows Up

Jack Rusteberg, age 4, announced yesterday, he wants to be an actuary when he grows up.

Willacy County Hires 90 Degree Benefits

Willacy County commissioners have approved 90 Degree Benefits as their third party administrator effective October 1, 2026 as a result of a a competitive Request For Proposal process.

Abbott Unveils Plan That Could Cut Texas Home and Auto Insurance Costs

Governor says roof fortification grants and auto insurance changes could reduce premiums

Expert Orthopedic Care When You Need It

From digital triage to orthopedic care, Upswing Health meets members where they are………………

PPO Physician Network + RBP = Best of All Worlds

Looking for a health plan that offers flexibility, affordability, and strong member support? Freedom Hybrid delivers the best of both worlds by combining a PPO physician network with the savings power of reference-based pricing.

What Does TrumpRx Do To Our GLP-1 Spend…….Nothing Unless You……

By Limitless Consulting

Since February, the most common question from benefits leaders has been a version of the same one: what does TrumpRx do to our GLP-1 spend?

Texas Hospitals Post Competitive Birth-Package Pricing For Pregnant Mexicans

The Texas Health and Human Services Commission has requested the Attorney General’s Office to investigate whether two Rio Grande Valley hospitals — Mission Regional Medical Center in Mission and Knapp Medical Center in Weslaco — had violated state or federal laws by purchasing a billboard that Gov. Greg Abbott says targets foreign nationals traveling to Texas to give birth.

Group Account Reps. Are The Backbone Of Any TPA

By Bill Rusteberg

Group account representatives are the backbone of any TPA operation. They are like sergeants in the Army, experienced front-line managers juggling many tasks important to the plan and TPA. They become the “face” of the TPA, a group’s contact, problem solver and friend. Loyalty between plan and group account representative often becomes the overriding byproduct, with TPA loyalty of secondary importance.

MEDICAL SERVICES CASH PAY PROGRAM ELECTION FORM

The process is simple, a business transaction where buyer and seller agree on price, not a faceless back room third-party intermediary whose pricing methodology is grounded in moral hazard.

This simple process requires legwork by plan members. They become an active part of the transaction, a responsibility they have never had before. And they are rewarded for their efforts when they succeed.

Cash Pay Health Plans Made Simple

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

By Bill Rusteberg

Plan sponsored Cash Pay Health Plans don’t have to be complicated. The process is really very simple, a business transaction where buyer and seller agree on price, not a faceless back room third-party intermediary whose pricing methodology is grounded in moral hazard.

NEW Group Health Insurance PPO Plan

Groups as Small as 1. Contact us to get starte . Call (813) 988-3200

Region One Annual Conference At South Padre Island

We are excited to share new updates for the 4th Annual School Finance & Operations Conference + Purchasing Coop Product Show. The conference is open to all Texas school systems, including district and campus administrators, human resources, payroll, procurement, budgeting, school finance, grants management, and operations professionals.

AI self-diagnosis rises in Iran as healthcare costs drive patients online

An Iranian doctor in this file photo checks a patient’s blood pressure during a medical examination at a healthcare facility in Iran.

July 13, 2026, 10:23 GMT+1 SOURCE: https://www.iranintl.com/en/202607130817

Patients in Iran are increasingly turning to artificial intelligence for medical advice as healthcare costs outpace household incomes, prompting concerns from a public health expert that the technology could undermine treatment and trust between doctors and patients.

You’re A Deadbeat Until You Prove You’re Not

” This is like…………guilty until proving yourself innocent. The public record shows Leon owes money he refuses to pay. That makes Leon a deadbeat. Now, it’s up to Leon to prove he’s not. Most would rather pay tribute to keep their reputation intact even though that would be wrong. The hospital should pay Leon $420 in reputational damages. Bastards!” – Molly Mulebriar

Working The Margin

“Your margin is my opportunity” says Jeff Bezos. American health care finance (insurance) has margins in every crook and cranny. There are up to over 26 margins in a group health insurance plan attracting pigs to the trough.

When Was The Last Time You Reviewed Your Coverage?

By Mathew Brown

The only requirement to sell you a commercial insurance policy in the US is passing a test, typically after two to three days of study. That low bar means there’s no shortage of brokers, but very little competition on thoroughness, and unless you scrutinize yours, you’re likely either underinsured or overpaying.

Compare Your Rates With National Average Group Medical Rates

No matter how you slice it, here is a good idea where group medical rates are in today’s market.

Brownsville ISD Considers Direct Primary Care

Better Care for Staff. Lower Costs for the District.

Brownsville ISD is projected to save $4–11 million annually by implementing DPC for employees. These savings come from fewer ER visits, fewer specialist referrals, better chronic care, reduced absenteeism, and lower pharmacy costs.

Kilpatrick Companies

We are the largest GA in our markets by market share with a company that bares our family name.

Amwins adds Texas non-subscriber MGA Jackson-Lloyd to ASCS

Deal adds occupational accident coverage as Texas’ non-subscriber market keeps shifting and Amwins keeps buying specialty MGAs

By Mark Rosanes Jul 02, 2026

Amwins has acquired Jackson-Lloyd, a Texas-based managing general underwriter specializing in non-subscriber occupational accident coverage. The company will join Amwins Specialty Casualty Solutions (ASCS).

The Modern Level-Funded Health Plan

Angle Health is built for today’s employers. We provide flexible level-funded health plans designed to be simple to manage and use.

Census driven firm pricing…………

Lawmakers Target the Power of Health Insurance Giants

UnitedHealth Group, CVS Health and Cigna are battling efforts to break up their control over prescription drugs.

Taxpayer Outrage, Double Taxation & The Power of Free Market Choice

By Bill Rusteberg

UMC Health System in Lubbock, Texas 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.

2027 ACA Marketplace Rate Filings

By Stacy Mays

The opening bids are in. Health plans have started submitting their proposed 2027 ACA premium rates to state regulators. Now the negotiation begins.

Lantanapropst Eye Drops

Mark Cuban Rx price is $7.28. What’s your copay? $10?……..$20?

Try asking your pharmacy what a 30 day supply of Lantanapropst cost. We did. The power of cash is an advantage insurance plans don’t offer.

Flesh Eating Parasite Invades Texas

Texas screwworm cases by county, according to the U.S. Department of Agriculture.(kbtx)

New World Screwworm Spreads Across Texas, Threatening Livestock and Beef Prices

TrumpRx

President Trump discusses drug prices while flying high………….

Pet-USA™

75% of claims paid within 24 hours, 95% within one week. Rated best pet insurance on the market.

Lloyds of London Is Not An Insurance Company

By Kingsly Kwalar

If you are new to insurance, you are probably grappling with what they mean when they say “Lloyd’s is a marketplace.” You are not alone because it sounds ordinary. Like a place where things are bought and sold.

O’Neilism

“Most business owners I know, didn’t start their business to be an insurance company. That’s why defined contribution health is taking over. If the results of all the magic tricks to stem the trend of health care over the past twenty plus years had been effective, maybe ICHRA would not be so popular”. – Brad O’Neil

This Is What Can Happen When You Have An Open Rx Formulary

By Bill Rusteberg

Small group plan maintains an open Rx formulary, a ticking time bomb.

Texicare Health Plans Expanding To 2-500 Employee Lives

Starting with 10/1 effective dates, we’re excited to extend Texicare health plans to Texas businesses with 2–500 employees.

Frontier DPC Q1 2026 Investor Report

Plan Sponsors As % Of Total Members

Five Texas political subdivisions make up 78% of total membership

RiskManagers.us Blog Statistic

IMPORTANT PUBLIC SERVICE ANNOUNCEMENT

By Lawrence Rogak

Warning: if the sign below traumatizes you, AVOID Interstate 95 in Florida at the former West Palm Beach Airport!

United States of Care

SOURCE: United States of Care

At United States of Care, we are listening to people’s needs, developing policy solutions, and partnering with others to ensure our health care system works for everyone.

Reference-Based Pricing (RBP) is No Longer A Fringe Phenomenon

Why is Texas not following other states towards adopting Reference Based Pricing strategies for government health plans like TRS ActiveCare and ERS? Could it be something to do with money?

I Can’t Sell A Health Plan Without A Logo!

Wally Wallbanger Suffers Mental Breakdown

By Wally Wallbanger

I can sell a health plan that guarantees double digit rate increases year after year along with increasing deductibles and out-of-pocket costs ultimately resulting in functionally uninsured plan members whose employer “cares about them.”

How Much Can I Sell My Life Insurance Policy For?

Most people with life insurance never collect. That’s because many simply let their policies lapse. Life insurance companies count on that. Don’t let your life insurance policy lapse. Sell it instead. It’s worth something.

Why ICHRA—and Choice—is so American

By Brad O’Neil

America was built on the idea that people should have the freedom to choose.

Texas School District Attempts The Impossible – Will They Succeed?

The following is a true story………….

A South Texas public school district tries new risk management strategy designed to reduce costs by reducing costs….. while keeping benefits exactly the same.

Paying Too Much for Car Insurance? It Might Be Time to Compare Rates

Auto insurance premiums have climbed significantly over the past few years, and many drivers are paying more than they realize simply because they haven’t shopped around recently.

ACA Compliant Health Plan For Large Groups

Large groups are required to offer ACA qualified health plans or face government punishment. Here’s a plan designed to pass government inspection while keeping plan costs as low as possible.

Texas Secures $34 Million AstraZeneca Settlement

Texas Attorney General Ken Paxton secured a nearly $34 million settlement from drugmaker AstraZeneca on Monday over alleged illegal kickbacks tied to Medicaid prescriptions.

The Value Of A Generic Only Program

By Bill Rusteberg

Most plans these days are not health plans anymore, they are drug plans with diminishing left overs to cover everything else. Drug costs can be as high as 40% of a plan’s spend and it’s increasing every year.

Offshore Rx Sourcing

SOURCE: ElectRx

A trusted Personal Importation program that delivers 40–60% savings on eligible prescriptions.

Virtual Direct Primary Care Costs 80% Less Than Brick & Mortar DPC

Paying $80 PEPM for direct primary care? Did you know over half of the visits are through virtual encounters? Why not subscribe to virtual direct primary care and save 80% of the cost while getting the same results?

$80 vs $12 PEPM………………

COBRA Is Not Always The Best Option

By Nick Depke

Nobody tells you this when you get laid off. Losing your job might actually lower your health insurance costs. Here is why.

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.

Insurance for the 21st century With Super Fast Everything

Hassle-free digital experience. Lightning fast claims payment. Powered by AI

We are a public benefit corporation. We take a flat fee on premiums up front before we pay claims. Then, we donate what’s left to meaningful causes our customers choose

Why Are You Insuring THAT!

By Jennifer Revell

Most employers are insuring the wrong 75% of healthcare spend.

Large Employers Embrace ICHRA

SOURCE: 2025 HRA Council Data Report

Large employers tired of being in the health insurance business are adopting ICHRA in greater numbers than ever before. Employees get better coverage based on their indivudual needs. And best yet, and for the first time, many employees can afford family coverage made possible by federal subsidies.

Don’t Let Your Life Insurance Policy Lapse……….Bank It

“Bill, I heard people can sell their life insurance policies. Do you know anything about that?”

How a Texas-linked Network Fueled An Alleged $3 Billion Medicare Fraud Scheme

By Brian New

June 25, 2026 – CBS Texas

What started as suspicious charges for catheters on seniors’ Medicare statements has grown into a massive international fraud case, with prosecutors alleging a Texas‑linked network generated billions in false claims, according to a federal indictment unsealed in the Southern District of Florida.

Government Just Proved Low Rx Prices Are Illegal If…………………

By Forest Park Pharmacy (Article Referred By Lori Ramos)

The Department of Justice just proved my point.

Last week a supermarket pharmacy chain — Ahold Delhaize, the parent of Giant, Stop & Shop, Hannaford, and Food Lion — agreed to pay $40 million to settle False Claims Act allegations. The charge: they reported inflated “usual and customary” prices to Medicare Part D, Medicaid, and TRICARE, and in doing so made the government overpay on prescription after prescription. $32.9 million of that goes back to the feds, the rest to state Medicaid programs.

PRIZM

Comply with Transparency in Coverage requirements by providing a shopping tool that allows members to estimate cost-sharing for covered healthcare services and procedures.

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……..”