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Risk Managers Blog 09/14/2019 19:09
“They are using our money, so overpaying there is no consequence to them………So it is easier for them to pay the bills as they come in, whether they are appropriate or not……………..” Robotics firm: Blue Cross got lazy, ripped us off Sues insurer over paying inflated, fraudulent medical bills A Southfield-based robotics company and Fiat […]
Risk Managers Blog 09/13/2019 09:44
By Bill Rusteberg School districts are entitlement based bastions whose decision making processes heavily weight social considerations at the expense of prudent business decisions. Ask almost any Texas school district what their experience has been under self-funded health plans either now or in the past (prior to TRS ActiveCare 2001) and you will likely get […]
Risk Managers Blog 09/12/2019 11:14
The job pays $65,000 per year plus benefits. By the time we add up all the benefits including health insurance, workers compensation, FICA, etc., your job is worth $85,000. But why would I hire you? Your pre-employment physical shows you are a walking health claim worth +$100,000 this year which brings your job value to […]
Risk Managers Blog 09/12/2019 10:44
By Bill Rusteberg A favorite strategy to lower health care costs by plan sponsors is by changing logos on one’s I.D. card. Everything else remains essentially the same. Benefits include in-network providers and out-of-network providers. Plan members are punished if they purposely or not seek care from out-of-network providers. That’s not too much of a […]
Risk Managers Blog 09/11/2019 10:22
“In the real market, healthcare costs are flat.” – Dave Chase. By Dave Chase on Linkedin No article I have written has awakened more people than this Forbes piece Have PPO Networks Perpetrated The Greatest Heist In American History? — including benefits brokers who are supposed to know this stuff. Countless benefits pros have told me […]
Risk Managers Blog 09/08/2019 13:34
You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?” The Rise of Reference Based Pricing By Bill Rusteberg For 35 years we have lived in the world of managed care. Consumers have been conditioned to believe networks of “preferred” providers […]
Risk Managers Blog 09/07/2019 22:12
Medical trend continues to outpace general inflation. Those plan sponsors who abide by the law of civil obedience continue to fund the health care beast’s insatiable appetite while others are taking a different approach. The later have solved health care……….they have stopped feeding the beast………… Healthcare Cost Trends Not Looking Good The healthcare cost trend […]
Risk Managers Blog 09/03/2019 09:55
A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit. Regarding the later (ruined credit), that can’t happen anymore in Texas. (It’s Xmas In Texas – State Passes “No Credit Ding Law”) Now that Reference Based Pricing […]
Risk Managers Blog 08/30/2019 16:07
Mr. Sedgewick: “Self insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this a essential health benefit under the ACA?” Johnny: “Self funded plans are not subject to essential health benefits. Yes the plan sponsor can do […]
Risk Managers Blog 08/30/2019 16:07
By Bill Rusteberg Mr. Sidgwick: “Self insured plan wants to cap payments made for air ambulances to some arbitrary number, $20,000 for example. Does it matter that this is for emergency care, and is this an essential health benefit under the ACA?” Bill (pictured above, front row left): “Sir, self funded plans are not subject to […]
Risk Managers Blog 08/28/2019 08:35
Great leadership, great students…………….. John Hoang August 26, 2019 EDINBURG — School districts across South Texas are celebrating the results of state ratings for last year. Region One Education Services Center board of directors, leadership and local superintendents gathered Thursday morning to discuss the evaluations of districts in the area, which received top marks in […]
Risk Managers Blog 08/27/2019 14:10
A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital…… Article Referred by Mark Flores 08/25/2019| by Will Maddox| Share Post A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital in unpaid […]

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