First there was Goose Insurance, then we learn about Lemonade Insurance and Good Friday Health Plan. Now we hear about Pie Insurance!
Continue reading Weird Insurance Company Names Cropping Up Everywhere!
Gun Bill Includes Extension Allowing Kickbacks to Insurer’s PBMs
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 Get Sued Too
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.
Davita Stock Price Plummets – 10k Report Reveals Fears
Davita Locations
Certain payors have been attempting to design and implement plans by limiting the number of in-network providers, setting arbitrary provider reimbursement rates,……….
Continue reading Davita Stock Price Plummets – 10k Report Reveals Fears
Dialysis Limited Benefits Doesn’t Violate Medicare Secondary Payer Statute
“The question in this case is whether a group health plan that provides limited benefits for outpatient dialysis — but does so uniformly for all plan participants — violates the Medicare Secondary Payer statute. We agree with petitioner Marietta and the United States as amicus curiae that the answer is no.
Continue reading Dialysis Limited Benefits Doesn’t Violate Medicare Secondary Payer Statute
Bankrupt Status-Quo Health Plan Eyes Cost-Shifting Remedies
“There is no excuse for this! Poor risk management, old style remedies and believing in magic is a recipe for disaster!” – Don Pedro
Continue reading Bankrupt Status-Quo Health Plan Eyes Cost-Shifting Remedies
Cassie Brown
Insurance Commissioner Cassie Brown
Cassie Brown was appointed to serve as Texas insurance commissioner by Governor Greg Abbott in September 2021. She is the chief executive of the Texas Department of Insurance (TDI), overseeing the regulation of the third largest insurance market in the nation and the eighth largest in the world. The agency regulates approximately 2,800 companies and more than 700,000 agents and adjusters.
100 Million People in U.S. Saddled With Health Care Debt
6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.
Continue reading 100 Million People in U.S. Saddled With Health Care Debt
PBMs Could Be Driving Up Plan Sponsors’ Drug Costs
In June 2016, only two months after the contract term began, an individual’s claim for an erectile dysfunction compound medication totaled $405,325.43 over three months Continue reading PBMs Could Be Driving Up Plan Sponsors’ Drug Costs
Proposal to Import Drugs Creates Unusual Alliance in the Senate
By Victoria Knight
Harmony is not often found between two of the most boisterous senators on Capitol Hill, Bernie Sanders (I-Vt.) and Rand… Read More
Continue reading Proposal to Import Drugs Creates Unusual Alliance in the Senate
Bill Smart
https://youtu.be/iP9CzgHVv78
William Jackson Smart was a twice-married, twice-widowed Civil War veteran and father of 14 children……….
Summer Session 2022
A Public Purchasing Seminar – June 22, 23, 24, 2022 – Designed for Public Purchasing Professionals with special emphasis on the latest developments that are essential in public purchasing.
Free Hospital Care For The Uninsured!
Attorney General Bonta Issues Consumer Alert Following Reports of Hospitals Failing to Inform Patients of Options for Free or Reduced-Price Medical Care
“Only dumb people pay for health insurance in California” – Molly Mulebriar
5 Steps to Providing Better Employee Health Coverage: $0 Premium, $0 Copay, $0 Deductible
“Great turnout at TASB Summer Leadership Institute in San Antonio! My presentation was standing room only and about 20 Board Members were listening from the hallway. I’m excited to see so many districts ready to join this movement. Thousands more school employees will have access to affordable health coverage next year.” – Ben Clinton
Goose Insurance – Historic Change in Product Distribution
“Our current system of distribution through independent agents in their brick-and-mortar offices will be largely replaced with digital distribution channels like Goose and Lemonade Insurance startups. That’s the future and the future is now” – Bill Rusteberg
Continue reading Goose Insurance – Historic Change in Product Distribution
Attention Plan Sponsors – Stake Your Claim To $485 Million Rx Settlement
Ranbaxy exploited the FDA’s “abbreviated new drug applications” (ANDAs) in order to secure valuable first-to-file generic status and lucrative 180-day exclusivity that comes with the first-to-file status.
Continue reading Attention Plan Sponsors – Stake Your Claim To $485 Million Rx Settlement
New Sales Opportunity For California P&C Agents
How many Californians have guns? Whatever that number is, a proposed government mandate requiring liability insurance will bring fast and easy bucks to aspiring P&C agents. “George, you own a gun?” is the opening line sales pitch……………”Then you have to buy this policy or go to jail!” is the closing line………………”Sign here!”
Continue reading New Sales Opportunity For California P&C Agents
AMPS Offers Solutions For Hospital Sponsored Health Plans
Advanced Medical Pricing Solutions (AMPS) offers the consultancy experience, external contacts and integrated solutions you need to make it possible…………..
Continue reading AMPS Offers Solutions For Hospital Sponsored Health Plans
Texas Shuts Down Unlicensed Insurer – 65,000 Policyholders Affected
TDI orders unlicensed insurer, Salvasen Health, to wind down operations in Texas
The Texas Department of Insurance (TDI) issued a consent order (PDF) today requiring Houston-based operation Salvasen Health to stop selling unauthorized health insurance and begin an orderly shutdown.
Continue reading Texas Shuts Down Unlicensed Insurer – 65,000 Policyholders Affected
Does Free Cafeteria Plan Administration Constitute Rebating?
Cafeteria Plan Administrators offering “Free” administration services in return for selling insurance products earn commissions on insurance policies sold to plan members. Nothing wrong with that, sounds like a good deal. But are there any regulatory issues?
Continue reading Does Free Cafeteria Plan Administration Constitute Rebating?
Employers – It’s Time To Help Hospitals Achieve Their Charitable Mission!
Give Me Your Poor, Your Tired, Your Huddled Employee Masses…………..You may be surprised by how many of your employees are eligible for free hospital care!
Continue reading Employers – It’s Time To Help Hospitals Achieve Their Charitable Mission!
Clueless City Struggles With Health Care Costs
KEY TAKEAWAYS:
- Top two rated insurance consultants replaced with the bottom two ranked consultants proving it pays to be last
Continue reading Clueless City Struggles With Health Care Costs
Texas MedClinic Acquired By Community Health Partners
Dr. Bernard Swift, founder and CEO of Texas MedClinic
Texas MedClinic sold to larger private equity-backed network. The company announced the sale of 20 urgent care clinics to national operator Community Care Partners.
Continue reading Texas MedClinic Acquired By Community Health Partners
Go Farther Gasoline
A tankful of Go Farther Gasoline would sure go a long way towards easing the pain at the pump these days…………………..
Hospitals Fined The Equivalent of Two Hospital Admissions
“Don’t worry, it’s only a scratch. We’ll make it up on the next one or two hospital admissions”
Continue reading Hospitals Fined The Equivalent of Two Hospital Admissions
U.S. LawShield – Legal Defense Protection for Gun Owners
Texas Man Wins Arms Salesman of The Year
There is no other arms salesman on the entire planet even close to what this Gun Salesman of The Year has achieved! He has sold more guns in less time than anyone else in history. His secret sauce? Reverse psychology selling – “Hell, yes, we’re going to take your AR-15, your AK-47…..”
Continue reading U.S. LawShield – Legal Defense Protection for Gun Owners
Tesla Insurance
Community Care Partners
Community Care Partners is a physician owned and managed group of urgent care and primary care clinics serving patients across the United States under the brands Nova Health, SouthStar, Coastal and BestMed Urgent Care.
Yottaflow Offers Instant Online Stop Loss Quotes
MyHealthGuide Source: Yottaflow, 6/7/2022
CLEVELAND — Yottaflow is excited to announce brokers and TPAs can now obtain illustrative stop loss quotes instantly from Yottaflow’s quoting partners.
Continue reading Yottaflow Offers Instant Online Stop Loss Quotes
Aldeen’s Sunday Morning Bathroom Read
By Doug Aldeen, Attorney at Law
Lawyers are the fourth branch of government: If you cannot legislate or regulate it, litigate it.
Geico To Pay $5,000,000 For Car Sex?
Car insurer Geico may have to pay $5m after woman contracts STI in a vehicle………..
Howden Acquires TigerRisk
Howden acquires TigerRisk, creating “much-needed” fourth global reinsurance broker
Everything You Need To Know About Writing Professional Liability Insurance in 30 Minutes
Any business that gives advice needs professional liability coverage including insurance agents and consultants active in health care…………………..
What Does The Future of Healthcare Look Like?
The world of medicine is changing faster than ever, with new treatments and technologies being discovered all the time. The Medicine 2042 conference, taking place between June 8-9 in Tel Aviv envisions the future of medicine and science, and what that might look like in the year 2042 and beyond.
Continue reading What Does The Future of Healthcare Look Like?
Pay Your Hospital Bill with Salt Water
“You have provided me with a surprise medical bill. I am providing you a surprise medical payment …………..”
Wholesale Brokerage Expands Texas Footprint
The MGU unit acts as an underwriting manager for various insurance companies for which it primarily underwrites ICOA insurance, Texas Non-Subscriber and related insurance products.
Continue reading Wholesale Brokerage Expands Texas Footprint
I Don’t Have Time To Choose The Right Vendor!
Shortlister – An HR vendor selection community that helps empowered, data-driven technology buyers to find and choose the right vendor.
Continue reading I Don’t Have Time To Choose The Right Vendor!
Dostarlimab
18 rectal cancer patients were given dostarlimab every three weeks for six months and ended up cancer-free………………………….“I believe this is the first time this has happened in the history of cancer………”
Another Virtual Healthcare Offering Hits Market
Benefits include unlimited virtual visits with $0 copay and $0 deductibles, capacity to treat over 1,500 conditions, the ability to prescribe medications and write orders for labs, x-rays and other diagnostic tests………………….Dedicated physician, $1 drugs………….
Continue reading Another Virtual Healthcare Offering Hits Market
Backstory On This Whole Rx Rebate Fandango
As Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean……………..
Amber’s Homeowners Insurance Policy To The Rescue?
“While legal experts say using homeowner’s insurance policies is common in defamation cases, Virginia lawyer Jeremiah Denton told The Post that most policies have a clause that stipulates judgment costs will not be covered.”
Continue reading Amber’s Homeowners Insurance Policy To The Rescue?
Obamacare Premiums Set to Spike By 53%
“What turned the Joker into Joker was losing his government-subsidized mental health care. His whole life went to shit because the government made him dependent and then pulled the rug out from under him.”
Radion Health
A 400 life case can be underwritten without claims experience or individual health questions? That’s interesting………….Is experience rating becoming a thing of the past? Continue reading Radion Health
We Want Your Stop Loss Business
Web based real time on-line final rates, immediate firm quotes, no participating requirements, quote down to 10 lives……………………level funding made easy
State Farm Email Solicits Agents For “Unique Project”
“On January 18, 2022, State Farm sent an email recruiting its agents for a “unique project”. Consumers’ Research obtained a copy of that email, and we knew we had a duty to alert the public.”
Continue reading State Farm Email Solicits Agents For “Unique Project”
The $1,000,000 Vitori Victory© Guarantee
Meet the Vitori Victory© Guarantee, the first of its kind. This health plan savings guarantee will reimburse you up to $1,000,000 if we don’t hit your savings target.*
FDA: Pharmacists and Wholesalers Can Import Drugs From Canada
“How Sweet It Is…………………….!
Pharmacists and wholesalers can import drugs from Canada but only as part of state programs ……………meanwhile, back at the ranch, everyday Americans are importing Canadian drugs for personal use often facilitated by plan sponsors under the personal use doctrine achieving significant savings. An 800 life San Antonio employer ran 12 months of paid drug spend through CANARX and found they could have saved over $800,000………A county government employee health plan has saved millions by importing Canadian drugs for personal use of their plan members since 2004…………….
Continue reading FDA: Pharmacists and Wholesalers Can Import Drugs From Canada
No Surprise – “Pure” RBP is Always Superior
The most effective way to address the NSA legislation, particularly elements of the IDR process, is to adopt a “pure” RBP plan.
Continue reading No Surprise – “Pure” RBP is Always Superior
Health Insurance Stocks Through The Roof!
Health Insurance Carrier Stock Performance Has Been Amazing!
Latuda
The cost for Latuda oral tablet 40 mg is around $1,503 for a supply of 30 tablets according to drugs.com. That’s $50 per pill.
CARE2CARE INTERNATIONAL – A Complete Suite of Rx Services
In 2019, C2CRx member companies spent 47% PMPM less than the Industry National Average; Since drugs represent 20 to 30% of a plans costs, this represents 10 to 12%
Continue reading CARE2CARE INTERNATIONAL – A Complete Suite of Rx Services
Specialty Drug Risk Transfer Strategy – The Hot Potato Method
The evolution of specialty drug risk transfer gains speed as more employer sponsored health plans face crippling and unsustainable costs for drugs that shouldn’t cost that much………………and don’t in other countries.
Continue reading Specialty Drug Risk Transfer Strategy – The Hot Potato Method
Memorial Day 2022
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.
More Employers Are Transferring Specialty Drug Risk
Employer: “Specialty Drugs Aren’t Covered!”
The best way to avoid risk is to eliminate it. That’s what more employers are doing these days with high-cost specialty drugs……………
Continue reading More Employers Are Transferring Specialty Drug Risk
Aldeen’s Sunday Morning Bathroom Read
Sunday morning bathroom read (Bill Burr edition)………………….
Veterans Day Tribute – A Kraut’s Dilemma In Combat
A Kraut’s Dilemma in Combat
By Col. E. Rusteberg
At the time of the Battle of the Bulge in WWII, my unit was in charge of the defense of a small village in Alsace.
Continue reading Veterans Day Tribute – A Kraut’s Dilemma In Combat
The Billion Dollar Shell Game
“Median prescription drug manufacturer pre-rebate costs per covered life increased by 54.5% for individual plans, 24% for small group plans, and 7.6% for large group plans annually……”
TRS ActiveCare Touts Low Administration Costs, Economies of Scale
Truth, fiction and word smithing intertwined requires expert unpacking for the benefit of clueless laypersons. With that in mind, the following applies.
Continue reading TRS ActiveCare Touts Low Administration Costs, Economies of Scale
Status Quo Solutions For Status Quo Health Plans
Cost Containment Strategies Haven’t Changed In 18 Years
This 2004 report by the State of Texas outlines strategies employed towards controlling rising medical costs that haven’t changed since. The solution? Reduce benefits and cost shift to plan members.
Continue reading Status Quo Solutions For Status Quo Health Plans
What Ever Happened To The 75% Participation Requirement?
Back in the day insurance companies required 75% participation of eligible employees to achieve an acceptable spread of risk. Now we see carriers requiring much lower participation requirements. What happened?
Continue reading What Ever Happened To The 75% Participation Requirement?
Saving Money By Charging More
“Good news!” says the PBM representative, “Your generic spend equals 90% of total drugs dispensed, Good Job!”
“Wow!” says the CFO, “That’s awesome……. members are getting the cheaper generic drugs! We must be saving a ton of money!”
“Yes indeed, we’re saving you money by charging more!” purrs the rep.
Humberto Zamora
In reading today’s financial news I noticed an article about John Ruiz, a Cuban immigrant made good. He made his billions in the health care industry by recovering health claim dollars on a commission basis for his clients. (See article below)
Hospital Sued For Restraint of Trade, Monopolization & Unfair Competition
This is an action for restraint of trade, unlawful monopolization, and unfair methods of competition seeking classwide damages and injunctive and equitable relief under the Sherman Act, 15 U.S.C. §§ 1 et seq., and Wisconsin’s antitrust laws, Wis. Stat. §§ 133.01 et seq
Continue reading Hospital Sued For Restraint of Trade, Monopolization & Unfair Competition
Who’s Counting These +2,000,000 Surprise Bills?
“Who Me? I didn’t count those bills!
“In the first two months of 2022, the NSA prevented more than 2,000,000 potential surprise medical bills across all commercially insured patients………….”
Continue reading Who’s Counting These +2,000,000 Surprise Bills?
Business Insurance – Quote & Bind In Minutes – Same Day Coverage
A surprising number of new businesses were started during the pandemic, from online ventures to side-hustles-turned-full-time and more. These new businesses need liability insurance coverage, and Hiscox can provide it.
Continue reading Business Insurance – Quote & Bind In Minutes – Same Day Coverage
Daddy What Do You Do For A Living?
By Molly Mulebriar
“Daddy, what do you do for a living?” asks the son. “I destroy relationships” says the daddy.
Moving From One Status Quo Plan To Another Makes No Sense
By Bill Rusteberg
Imagine a group health plan option costing around $400 per month for single coverage and about $1,000 for full family coverage with no financial barriers to healthcare. No deductibles, no co-pays, no co-insurance and no balance billing.
Continue reading Moving From One Status Quo Plan To Another Makes No Sense
Ms. French vs Hospital Chargemaster
HOSPITAL: Our chargemaster says you owe us $229,112.13!
PATIENT: But you told me I owed only $1,300! What’s a chargemaster?
HOSPITAL: We make up absurd pricing so we can “negotiate” discounts with insurance companies like Blue Cross, United and all the rest. You’re not an insurance company. Besides, what’s a few extra bucks! Pay up!
PATIENT: What’s the 13 cents for?
Know Your Costs Before You Buy – What A Novel Idea!
By Bill Rusteberg
Under new government health care transparency rules health care consumers are now able to see prices before they buy instead of learning prices after they purchase services. What a novel idea!
Continue reading Know Your Costs Before You Buy – What A Novel Idea!
Josh Butler – “Rebates Are No Longer Where The Big Money Is……”
“PBM’s will acquiesce almost any rebate guarantee as long as they are still allowed to procure generic meds via an AWP discount method.”
Continue reading Josh Butler – “Rebates Are No Longer Where The Big Money Is……”
CLAIMS PROCESSING IN BREACH OF FIDUCIARY DUTY
How can consumers know for sure their claims are paid correctly? How can plan sponsors be sure too? How many take the time and effort necessary for proper plan oversight?
Continue reading CLAIMS PROCESSING IN BREACH OF FIDUCIARY DUTY
Homestead Targets Texas School Districts
TRS ActiveCare Official Reacts
“Texas school districts can improve benefits and remove financial barriers to healthcare while reducing costs at the same time based on proven risk management strategies that have been successfully operating in school districts for years.” Continue reading Homestead Targets Texas School Districts
An Antidote For The TRS ActiveCare Poison Pill Provision?
Want out of TRS ActiveCare immediately? There’s a provision in the Texas Administrative Code that can make that happen.
Continue reading An Antidote For The TRS ActiveCare Poison Pill Provision?
Pharma Bro Set Free From Prison
Martin Shkreli (pictured on the right) set free from prison…
Entitlement Mentality Meets Reality & Reality is Winning
NOTICE TO ALL EMPLOYEES: Where you go for health care is your business. How it’s paid is ours.
Continue reading Entitlement Mentality Meets Reality & Reality is Winning