Legacy health insurance brokers are worthless. They’re bad for your financial health. They’re lazy, dumb and often great golfers.
Continue reading Legacy Health Insurance Brokers Are Bad For Your Health
Here’s an opportunity for health insurance brokers to earn big bucks by simply forwarding this RFP to the four or five remaining fully insured carriers active in the market. Effortlessly, lift your index finger, gently tap the send button, and email the link below to your favorite BUCA rep. They’ll do the work while you play.
Continue reading City of Raymondville Seeks Competitive Health Insurance
By Christopher Chen, MD
Consider a typical primary care doctor who sees 30 patients a day, generating some $600,000 in a year ………………………..
Continue reading The Full-Risk Capitation Model: Why Make the Change?
July 26, 2022 at 4:47 AM CDT
In 2021 alone, pharmaceutical firms provided a staggering $204 billion in price concessions for brand-name medicines–but the funds have mostly benefited insurers and their pharmacy benefits managers.
A federal court recently exposed the rot at the heart of America’s health care system.
Continue reading It’s time to expose the secret drug scam at the heart of American health care
Retailers, payers and startups could capture 30% of primary care market by 2030: report
By Heather LandiAug 2, 2022 12:30pm
Bringing new care and reimbursement models to the market along with a bigger focus on virtual care, these nontraditional players are gaining traction and have the potential to grab as much as a third of the U.S. primary care market by 2030, according to a new report from Bain and Company.
Continue reading The Primary Care Gold Rush
Emerging Leader Accelerates Growth Trajectory and Market Penetration
PONTE VEDRA BEACH, FL / ACCESSWIRE / August 3, 2022 / ReviveHealth™, Inc. has announced they have acquired ManifestRx™, an innovative national digital pharmacy services platform, as they continue their quest to become a preeminent leader in digital health whole-person care.
Continue reading Revive Health Expands Growth Trajectory
The parents of Maddux Brown saved big when they learned that nonprofit hospitals are required to provide financial assistance. You and your loved ones could, too!
When 6-year-old Maddux Brown underwent a 15-minute surgical procedure his dad Jason didn’t expect the bill to empty his bank account.
Continue reading How Would You Deal With An Unexpected $1,908 Hospital Bill?
“If your PBM contract pricing includes AWP-X% you are getting screwed. If the contract also includes MAC pricing you’re getting doubly screwed” – Molly Mulebriar
Continue reading How To Secure Good PBM Contract Terms
RiskManagers Blog has been down the last few days with readers getting the message “Access is not available on account of abusive activity.”
Continue reading “Abusive” Blog Reinstated
Zelis Healthcare, backed by Parthenon Capital and Bain Capital, has agreed to acquire Payer Compass for roughly $180 million, sources familiar with the matter tell Axios.
This 800 pound gorilla is located in deep South Texas, in the Lower Rio Grande Valley.
Continue reading 800 Life Case Seeks Health Insurance Proposals
Dr. Benjamin Clinton explains how the poorest school district in Texas solved health care………..
Continue reading Texas School District Explains How They Solved Health Care
Blue Cross has given a small school district in deep South Texas a better deal than TRS ActiveCare with over 400,000 members………………. Continue reading Blue Cross Gives Small School District Better Deal than TRS ActiveCare
By Bill Rusteberg
I’ve been dealing with hospital administrators since the 1970’s and during the years since little has changed. I know exactly what the hospital administer will say and do during the negotiation process, their tactics, including the traps they set for amateurs.
Continue reading When Reason & Logic Won’t Win The Argument, Arm Twisting Will
By Bill Rusteberg
Recently I was referred to a large medical group that was interested in learning more about how we help plan sponsors manage their employee health care needs. They were fully-insured with a BUCA and tired of double-digit rate increases year after year.
Continue reading You Don’t Want Me To Know Your Business Because It Won’t Be Good For You!
Amazon is acquiring One Medical for $18 a share, an all-cash deal that values the primary health-care provider at roughly $3.9 billion, the companies said Thursday.
New England Journal of Medicine reports a transformational therapy has effectively cured the Royal Disease………..
Separating The Sheep From The Goats – Matthew 25:31–46
I have hated this business for a long time but I love being an outlaw helping companies escape the prevailing death spiral…………………………..
“Don’t bother doing something unless your radically different from the competition”– Richard Branson
By Bill Rusteberg
Building a Rx benefit plan without a PBM (Predatory Business Model) is beginning to make sense for plan sponsors whose Rx costs are as high as 50% of total plan spend. They no longer view their plan as a health plan but as a Rx plan with health benefits attached.
Continue reading Build Your Own RX Plan – Bypass Predatory Business Models (PBMs)
While chasing a squirrel in the woods, beloved pet dog tore the anterior cruciate ligament in her left knee. Turns out she had better insurance than her master………………………………
Continue reading My Dog Has Better Health Insurance Than I Do!
If Paul Harvey were alive today and had read the following article, he would have found fertile material for his “The Rest of The Story” radio show…………………………
Plan Sponsor Employs Discretionary Authority
Does your plan contain a discretionary authority provision? The government may be taking that away if HR 7740 passes. It will prohibit arbitration in ERISA claims and discretionary authority clauses.
Continue reading Plan Sponsors To Lose Discretionary Authority?
Are PBM’s Adding Another Middleman To Avoid Transparency?
Are PBM’s creating another intermediary in the supply chain to prepare for transparency requirements? They stand to lose a lot if they get regulated on rebates. By creating another organization that’s offshore, they can protect their interests…………….
Continue reading PBM Shell Game – Hiding Fees Through Middlemen
AUSTIN, TX – “He’s turning into a shell of his former self”, his wife cried.
Lee had become so frail that it took every ounce of energy just to hoist himself out of his scooter and into his favorite Lazy Boy.
Formulas for establishing health insurance renewal rates:
Continue reading Underwriting Health Insurance Plan Made Easy
Article Referred By Jody Bright
Pharmacists can now prescribe Paxlovid, Pfizer’s COVID-19 antiviral pill, directly to patients.
Continue reading US Allows Pharmacists to Prescribe Paxlovid Directly
Prescription drugs don’t have to be as expensive as they are. A smart plan sponsor, thinking out of the box, would discover tremendous savings if they seize advantage of opportunities available in the free market.
“Pharmacy Benefit Managers are one of the three most influential opponents of price transparency……………….. If the true cost of a medication were known this would shine a light on the fraud taking place, so the PBMs hide the costs at every turn”
SOURCE: Vitori Health
Twenty years ago, nearly two-thirds of doctors were independent practitioners. Today, only one-quarter remain independent.
Continue reading Only 26 Percent of U.S. Physicians Are Still Independent. Why?
Once Upon A Time there was a young man in dire need of medical care but he had no insurance………….
Protecting patients,
health plans and insurers
across the U.S.
“We engaged Koehler-Fitzgerald in 2015 to represent covered employees of health plans we provide administration to that have adopted reference based pricing. They have been very responsive to the needs and questions presented by plan sponsors, plan members, and our staff. Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. Knowing that every participant has legal representation from a high quality, experienced law firm provides our client plans and employers confidence that their employees will be properly protected from the many aggressive balance billing practices that a small portion of hospitals and other medical providers attempt to employ. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.” – Jim Farley, J.P. Farley Corporation
Continue reading Law Firm Manages & Reduces Risk For RBP Plans
A national poll conducted by the Molly Mulebriar organization found 99.99999% of Americans hate their health insurance. The primary reasons cited include affordability.
Continue reading Poll – 99.999% of Americans Hate Their Health Insurance
Asserta is offering investors an opportunity to share in a fast growing segment of the American health care system of finance providing employers significant savings on health insurance costs while removing financial barriers and improving member experience for working Americans ………………
Continue reading Asserta Seeking Investors @ $7.95 Per Share
Specialty Drugs Have Consequences
During the interview process Joe Sixpack learns the position pays $35,000 plus benefits. Little does the employer or Joe know the true cost was going to end up being $650,000…..the equivalent of 18 jobs………..so to keep from bankruptcy the employer must reduce his workforce by 18 (hopefully non-essential) employees and freeze wages for everyone else ………….or move his manufacturing business to China and his $685,000 per year employee to unemployment.
Continue reading Specialty Drugs Are Bankrupting Health Plans
MyHealthGuide Source: Voya Health Solutions*, 7/5/2022
Voya Health Solutions* is pleased to announce their continued expansion into the mid-market beginning with quoting on July 1, 2022.
Continue reading Voya Health Solutions* Expands Stop Loss Presence in The Mid-market
“The supposed firemen are arsonists…getting rescued and then robbed shouldn’t happen”.
Rancho Pescadero Wellness Center offers a unique approach to wellness…………….
Continue reading Finally, A Wellness Program That Makes Sense
This blog entry is directed towards PBM experts who are not PBM’s or employed by a PBM. We are searching for the truth about the deep black vortex of the PBM world……………
“Reimbursements for overrides are taxable if not provided a written plan as required by Code Section 105. If taxable, reimbursements should be reported on employee W-2s and all applicable income and employment taxes should be withheld and reported as required by the IRS….”
Continue reading Carving Out Specialty Drugs May Have Consequences
“Pssst….Godfather, We’ve Been Exposed!
The following account is based on a true story.
If a Reference Based Pricing plan pays medical caregivers 120% of Medicare, what is the Plan Sponsor paying?
“Prudent plan fiduciaries will establish and adhere to a formal, written policy to ensure compliance with the New Disclosure Rule. Indemnification and limitation of liability provisions in service provider contracts should also be revisited relative to this new rule.”
Continue reading Brokers Rejoice! Compensation Disclosure Not Required For Non-ERISA Groups
Eagle Pass Independent School District has got to be paying more for health insurance than any other school district in Texas…………………..
Continue reading Texas School District Wins “Highest Cost Health Insurance” Award
By Doug Aldeen
Sunday morning bathroom read (Happy 4th of July): Slowly but surely (more like a glacial pace) the python like grip of the industrial medical sick complex is loosening… .
Continue reading Aldeen’s Sunday Morning Bathroom Read – Happy July 4 Edition
“Some things are worth getting mad about. The hospital cartel is using taxpayer dollars to help crush the middle class and rob lower-income families of upward mobility…………Wealthy hospitals took billions of taxpayer dollars meant to protect struggling hospitals — and then some billed poor families or even sued patients.” – State Treasurer Dale R. Folwell, CPA
Continue reading Elected Official Mad As Hell – Hospital Cartel Crushing Middle Class
Dogs are “superior smellers” and are already used to detect what the human nose typically cannot from diseases, such as Parkinson’s, cancer and diabetes, to drugs and explosives in public places, according to the American Lung Association.
California will become the first state to remove immigration status as a barrier to health care, making all low-income illegals eligible for state-subsidized healthcare regardless of age.
4 Out Of 5 Americans With Diabetes Went Into Debt To Pay For Insulin, New Survey Shows
By Deb Gordon
Amidst rising inflation, Americans are feeling the squeeze of higher prices on everything from gas to groceries. But when inflation bumps into the already rising cost of drugs such as insulin, the impact can be serious and the stakes are high.
Continue reading Dr. Banting Patented Insulin Over 100 Years Ago For $1. What Happened?
“What! I thought It was The French Connection!”
A county government in New York has been accessing Canadian prescription drugs through their self-funded health plan since 2004 with savings in the millions of dollars. Now we see more employers considering the same by moving away from traditional Predatory Business Models (PBM’s) as drug prices reach unaffordable levels in this country.
Continue reading More Plan Sponsors Eye The Canadian Connection
We are looking for the perfect TPA. Some of the qualifications are memorialized here: Selecting a Third Party Administrator.
Holms & Watson Remain Stumped
SOURCE: Vitori Health
A report by the PBM Accountability Project reveals the details of PBMs’ “evolving business models and revenue.” Despite the available financial data, the authors could not identify “the source of nearly 40% of PBMs’ total gross profit.”
Continue reading Predatory Business Model (PBM) – The Case of The Missing 40%
By Bill Rusteberg
“What color is that orange?” asks the first underwriter. “It’s yellow!” says the second underwriter. “It can’t be! It’s an orange!” responds the first.
Continue reading AAA – Solution To High Cost Ambulance Service?
ATTENTION EMPLOYERS: Do you have anyone in your health plan who is costing big dollars due to high-cost prescription drugs? The same drug may be significantly less expensive in Canada.
MEDSAVE MANAGEMENT LLC assists self-funded plan sponsors towards obtaining Canadian prescription drugs for plan members.
Continue reading Canadian Prescription Drugs Provide Savings For Health Plans
Some employers are moving away from offering traditional coverage with a provider network and instead are using reference-based pricing for some or all of services they cover.
Continue reading American Hospital Association Issues Fact Sheet on Reference Based Pricing
What did the cat say when the train ran over it’s tail?”
Continue reading States Move Ahead With Canadian Drug Importation
Article Referred By Brent Evans
There was once a frog who had been captured by his country and put in a cage. As he was a very scared and naive frog, he believed it when told it was for his own good.
How it Works
Continue reading Canadian Prescription Drug Importation Program
Employers may have to pay more in 2022. but here’s a solution………
For plan years beginning in 2022, coverage is considered affordable if an employee’s required contribution for self-only coverage does not exceed 9.61% of the employee’s household income.
https://youtu.be/UehilhnMt5Y?t=253
The Bottom Line: Brokers earn bonuses, vacations to keep companies from switching from Blue Cross
Continue reading Blue Cross: You Can Check Out Anytime You Like But You Can Never Leave
Put two lawyers in a room and they will come out with three different opinions………….
Continue reading Lawyers Have Field Day With Dobbs vs Jackson
RU-48 was developed in 1980 and came into use in France in 1987. It became available in the United States in 2000. It is on the World Health Organization’s List of Essential Medicines.
Feel-good email brings great news for plan members but threatens plan finances…..
Continue reading TRS ActiveCare Touts “FREE” Specialty Drug Benefit
New York Announces Special Medical Tourism Package Designed For Pregnant People…………
Continue reading New York State Set To Enter Medical Tourism Business
Realizing the decision to purchase will be based on worst case scenario, a broker can deliver the lowest bid every time if he knows how.
We need to know if he’s high. Has he been doing bong hits, blasting rails, chasing the dragon, and/or dropping acid? Is he hopped up on goofballs?
Continue reading Send This Man To Rehab! Will Insurance Cover It?
“The former insurance company worker described the experience of gliding under water, half-human and half-fish, as “meditation in motion.”
Who, Me? Nope I Didn’t Do It!
New Jersey Governor says he didn’t intervene in insurer dispute
Cash Pay Level Funded Plan Make Sense
Combining level-funded plans with locked-in cash-pay rates for medical procedures purchased prior to treatment creates an innovative cost containment network strategy for employers.
Amarillo Drug Dealer Earns Billions
Little did anyone imagine a drug dealer in West Texas (you can’t get there from here) would turn into a billion dollar business. It all started with a $21,000 loan from a loving mother.
“Please take the time to watch this compelling case study webinar that showcases what is possible when an employer takes a truly proactive approach to controlling the cost of healthcare claims” – Dan Meylan
Texas-based study raises questions about impact of using additional criteria in No Surprises Act arbitration cases
Continue reading Texas Based Study On NSA Arbitration Cases Raises Questions
SOURCE: Howard A Green, MD – Linkedin
Can’t make this shit up. US Congress sneaks into the current gun bill an extension allowing continued kickbacks to insurers pharmaceutical benefit managers screwing patients and their physicians.
Continue reading Gun Bill Includes Extension Allowing Kickbacks to Insurer’s PBMs
Lawyers Professional Liability Insurance
Zurich’s Lawyers Professional Liability Insurance Program offers Professional Liability/Errors and Omissions coverage to the following segments of attorneys: Law firms with attorney count of up to 100 attorneys; solo attorneys; part time attorneys and moonlighting attorneys.
