Risk Managers

A stand alone benefit option that can be added to any plan giving members a choice between free health care or not so free health care at the point of service.

Years ago I met a city manager who decided his city’s health plan could be administered in-house and stop loss was not necessary. “We will self-insure and win over time just like stop loss carriers do!” he said.

The NPI Registry is a free directory of all active National Provider Identifier (NPI) records. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry.

Since opening our doors in 2006, the BKS Holistic Protection™ model has produced double-digit growth and unprecedented client retention.

The government prohibits group health plans and issuers offering group health insurance from entering into agreements with providers, third-party administrators (TPAs) or other service providers that include language that would constitute a gag clause……………..

Warning: Do not watch this video if you have (a) High Blood Pressure, (b) Ulcers, or (c) Suicidal tendencies.

Ever told as a kid you couldn’t have something? So you were determined to find a way to get it come Hell or High Water?

Many small businesses in Texas have raised concerns that they cannot afford to offer traditional health insurance to their employees. As a result, many working families lack access to quality health care. One way to address this issue is through direct primary care.

Texans of all political persuasions are fed up with the high cost of prescription drugs and they are about to do something about it.

If a restaurant charged one person $10 for a meal and charged another person $40 for the same order, it would be considered price gouging—and rightfully so.

As compensation for its services under this Agreement, Gallagher will receive carrier commissions and/or direct fee owed by the Client, as set forth in the Compensation Disclosure Statement attached hereto as Exhibit B.

Sunday Morning Bathroom Read (Mother’s Day Edition)

“Gallagher would have a better chance of surviving a forest fire wearing gasoline underwear than trying to explain this…………..?

Looking to save money, the district didn’t go to the “medical mile” for a solution but rather it veered down a small, dead-end, poorly-patched street in Ashtabula where inside a historic home a man and his team are trying to make history by patching the broken business of healthcare.

Cash pay strategies are gaining traction in the market. Here’s a cash pay centric plan funded through individual, (but group paid?), Health Savings Accounts (HSA’s).

Jared Moskowitz bought Merck & Co Inc (MRK:US) on 2023-02-24

“People need to have confidence that policymakers are making decisions based on what’s best for the country, not what’s best for their stock portfolios.”

By Dean Jargo on Linkedin

When Americans sign up for traditional BUCAH-powered health insurance, what do most assume they’re getting? I believe the following objectives are top of the list for most folks:

BACKGROUND AND PURPOSE

An arrangement under which an employer can offer both workers’ compensation insurance and a workers’ health insurance policy would allow employees and their dependents better access to health care. H.B. 351 seeks to provide for a workers’ compensation insurance company to contract with an accident and health insurance company to offer to employers a workers’ compensation insurance policy and a group accident and health insurance policy together in one packaged plan.

SB 1781 is expected to pass and take effect September 1, 2023. The bill lays out the framework for public school districts to set up and govern health insurance cooperatives for the benefit of their members.

Ask Lynn. She got $180,000 for her $500,000 policy. She realized her life insurance was getting more and more expensive each year. Her children were grown and financially independent, so there was no need to keep the policy. She read about life settlements and decided to sell her life insurance for cash.

If you have clients on a traditional group plan, you can help them save more money while earning higher commissions with an ICHRA through Remodel Health.

A Risk Management Strategy Supported By The American Taxpayer

By Bill Rusteberg

The Compassionate Care Plan™ is a risk management strategy for self-funded employer groups providing an effective method of transferring high risk plan members to the individual health insurance market.

I always wondered how it was John (not his real name) seemed to be doing quite well working as a sales rep. for a rental PPO network. His wife didn’t work, he lived in an expensive neighborhood in a major Texas city, and was often vacationing at warm sunny beach resorts with plenty of umbrella drinks at hand. Life was good to John.

In February 2005, insurance broker Wesley Chesson submitted an application to Plaintiff Columbus Life Insurance Company (“Columbus Life”) for a life insurance policy on behalf of Dr. Earl Trevathan, Jr. The application, which was purportedly executed by Dr. Trevathan in Greenville, North Carolina, sought a $1 million policy with a $1 million rider, naming Dr. Trevathan as the initial owner and Dr. Trevathan’s estate as the initial beneficiary.

Reference Based Pricing is not new, it’s been around for a long time. Did you know that Texas Workers Compensation is a Reference Based Pricing plan?

El Paso ISD uses the CIGNA PPO network. Other districts nearby use Aetna and Blue Cross. Of the three networks, which one offers the best prices?

By Bill Rusteberg

Much has been written about the Raymondville Independent School District’s health plan over the past several years. Located in deep South Texas, this small rural school district has solved health care.

Ken Paxton explains how he identified adverse risk factors, quantified expected outcomes, and put into place a strategy designed to mitigate potential losses.

Become A Bona Fide Field Underwriter In Under 5 Minutes!

Josh Butler, President Butler Benefits

Attention Texas Panhandle Employers!

On Tuesday, May 23, we are hosting an exclusive event to introduce High Plains Health Plan to regional employers, HR professionals, and Civic leaders at Hodgetown Stadium. The formal event will run from 3:00 to 5:00, followed by Happy Hour and networking immediately after.

By Molly Mulebriar

Underwriting a self-funded group medical plan involves assessing the risk and cost of providing health insurance coverage to a specific group of employees or members.

Sec. 4151.002. EXEMPTIONS. A person is not an administrator if the person is:

17) a self-insured political subdivision

Insurance agent notches up Guinness World Record

91-year old receives recognition but is not yet ready to retire

Joe Sun Yung Tsu, a 91-year-old insurance agent, has been awarded a Guinness World Record for the “longest career as a corporate salesperson”, having spent 62 years and 238 days with Manulife Hong Kong.

The court stressed that “[t]he fact that [Blue Cross] could make claim payments only with the Fund’s authorization, along with the fact that the Fund retained full control over the appeals process, weighs toward finding that [Blue Cross] lacked authority respecting the disposition of the working capital amount.” 

For the underwriting process, the insurer receives detailed patient information at high resolution, from the questionnaire answers to results from specific lab tests. This data is used to completely personalize the insurance product, whether for pricing and actuarial purposes, underwriting, or management of the lifecycle of the policy and claims management. MPCheck supports a fully tailored approach to health insurance, and a completely different and more effective mode of risk management.

Sheba Virtual Hospital “Beyond” is making it possible for people to perform periodic medical examinations at work or at home.

This year, the Texas Legislature has the opportunity to repeal the anti-competitive, out-of-date state law guaranteeing Medicaid business to underperforming health plans.

Risk management is not a static or one-time activity. It is a continuous and dynamic process that requires constant learning and adaptation.

Ditch your traditional group health benefits once and for all………………..

Descendants of the Greatest Generation are definitely not Chips Off The Old Block……

Hospital Finance 101: Understanding the Cost of Full-Service Healthcare in Pullman, WA Program by: Steve Febus, Pullman Regional Hospital Chief Financial Officer Learn more at

http://www.pullmanregional.org/transp…

What a turnaround story…This is the poorest and one of the smallest school districts of over 1200 in Texas…………….

Fee based independent insurance consultants are comfortable within their own skin, confident their relationship with their client is founded on shared philosophies and goals. They know if they don’t produce acceptable results, they are replaceable. They’re good with that. They sit on the same side of the table as their client on equal terms.

“Benefits RFPs are universally awful and HR should abandon them…… RFPs are suited for buying a commodity, but not selecting a consultant……”

A warehouse filled with Magic Dust has been discovered in a remote area of DeWitt County. Governor calls upon school districts to remain calm………………

Weight Loss Program Costing Only +$12,000 Per Year! Who’s going to pay for this because most working Americans can’t?

“About eighty percent of the food on shelves of supermarkets today didn’t exist 100 years ago.”
― Larry McCleary MD

“I don’t think people realize that 54% of the nation’s children are covered by Medicaid,” Brooks said.

“We finally have a plan sponsor with the guts to do this,” Tony Sorrentino, a lawyer who is president of Health Plan Fiduciary Compliance LLC, a health-care compliance consulting firm based in Parker, Colo., said in an interview.

Why was her employer’s small group plan paying for it? And now it’s “free”?

This afternoon Katrina Daniel will be presenting an update on administration and performance of TRS-ActiveCare, a government health plan for Texas school districts. The Board Packet will be posted here later today.

A first hand, eyewitness account of the movement of Jews to Palestine after WW2 as told by a 99 year old WW2 American soldier, Herbert Margol, February 18, 2023.

Have you ever received an email so compelling you want to know more? You like the message, but wonder “What the Hell is this all about?” So you click on the link provided hoping to learn something new and exciting that will help your clients save money on health care. But doing so may have provided a complete stranger a door without a lock to your basement vault.

Artificial Intelligence (AI) is amazing. The following was generated in under 30 seconds by AI software when prompted with “Create Direct Primary Care Proposal”:

As a benefits consultant actuary services are core to your business proposition value……..

Because healthcare is local, we create programs built around your community, not national boxed programs that may or may not fit your unique needs. Gain more control with lower costs, reduced uncertainty, and increased transparency.

What kind of strategy saves money over Reference Based Pricing schemes? That’s probably what you’ll be wondering after reading this latest blog posting and a visit to Highlight Health’s website. That’s on purpose. But we know the secret – can you guess what it is? Hint: Doug Aldeen, famed Austin, Texas ERISA attorney is considered by many to be the Godfather who started this national movement………………..

Plum Health provides excellent health care services. We focus on prevention and wellness. We want to partner with you to create better health outcomes by providing compassionate service in a timely manner.

Ozempic is a popular diabetes medication that also helps with weight-loss. The other name for Ozempic is #Semaglutide. At higher doses of 1 mg per week it suppresses appetite and can lower weight by 10-13lbs. Ozempic is only approved for Type 2 Diabetes, NOT weight-loss. Ozempic costs about $995 per 8 mg pen… which could potentially last you almost 2 months. It suppresses appetite even more and can lead to 35lbs of weight-loss. Wegovy is approved for weight-loss. Wegovy costs about $1,432 per month.

School districts can reduce health care costs and improve benefits at the same time if they want to. It’s all about leadership.

Former Ashtabula Area City Schools Superintendent Mark Potts writes that the district’s experience shows the cost-reduction benefits of being able to shop for public employee health plan coverage as a price-informed consumer.

Same Day Prescription Drug Delivery

Add virtual care and you will almost never need to take time off from work to see a doctor at 2:00 for your 11:00 appointment

SOURCE: The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

“Uber Health is foraying deeper into healthcare with a new feature that allows providers to order prescriptions to be dropped off at patients homes same-day. The same-day prescription delivery is meant to help patients adhere to a medication schedule.”

Plan Sponsors Enjoy Pain & Suffering – Embrace Self-Flagellation

The article below (click on link for full article) doesn’t shed light on anything new. These practices have been going on for years. There have been hundreds of lawsuits exposing these egregious practices including Weslaco ISD vs Aetna, Anheiser Busch vs Cigna, Hi-Lex vs Blue Cross, Oakland County vs Blue Cross. Chippewa – Luce- Mackinac Community Action vs BCBS and many more.

Plan sponsors can’t afford to offer plans where plan members can go to any pharmacy, pay the same copay regardless of the retail price, and have the cost funded at the point of service using other people’s money.

Faster than a speeding bullet, more powerful than a locomotive, able to leap tall buildings at a single bound—look, up there in the sky, it’s a bird, it’s a plane, it’s First Connect!

“Trulicity was heavily marketed to doctors despite a high NNT, number needed to treat. NNT tells you how many patients need to be treated and for how long for one patient to benefit from the drug. It turns out that we have to treat 327 people for three years to prevent one non-fatal heart event, and that treatment costs $2.7 million.”

Plan member screwed by his own health plan

What do you mean I owe $5,000! The cash price for the whole thing was $87! You have a fiduciary duty to make sure things like this don’t happen! You should have had a cash pay health plan option like MedSave! You knew that option was available but you didn’t do it! I’ll see you in court!

Writing group medical insurance is a pain in the ass. You need detailed claim information for the past two years, census data, large case management notes and a whole lot of patience working with picky underwriters who always want more. Getting a firm quote takes days and weeks.

The Most Innovative Healthtech companies To Watch 2023

The federal government’s endorsement of RBP solidifies its position as a legally viable and effective health care pricing model. Fiduciaries must consider federal regulations, guidance, and legal precedents that support the use of RBP when evaluating its potential benefits. The endorsement by the federal government serves as a strong signal to fiduciaries that RBP is a legitimate and beneficial option for health insurance plans.

A BUCA renewal on a +200 life, fully-insured case warns the information contained in the re-rate calculation is CONFIDENTIAL and proprietary. Therefore we cannot confirm or deny its Blue Cross.

Dave and Erin, from Buffalo, New York, met foraging in dumpsters 14 years ago. They are still finding treasures together today.

SOURCE: The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Thousands of doctors are expected to reach retirement age in the next three years, and their replacements won’t be physicians.

So much for your promises. You’ve given me nothing but shattered dreams……………….

MEDSAVE MANAGEMENT LLC is pleased to announce a new health plan option members may choose when seeking medical care. This program is designed for self-funded health plans interested in achieving additional plan savings while improving benefits at the same time without disrupting existing relationships.

It’s a new type of health plan you never heard of………………….

Blue Cross pays participating doctors lucrative commissions through what we call their Wuhan Virus Preventative Care Program (WVPCP).

Superintendent Stetson Roane (on left), Ben Clinton Assistant Superintendent (on right)

A case study of how to build a pay-for-itself community health clinic with other people’s money while making a profit at the same time…………………