Custom Benefits Solutions

12/04/2025

10/24/2025

I'm going to keep this short because it's Q4 and there's hardly any time for posting. But, I just couldn't help stating the obvious here.

Q: "Upcoding or downcoding...which is justified"?
A: "Neither, this is why you don't want insurance companies paying hospital claims if you can help it. This is why you need to be empowering employees with cash pay strategies and nurse care navigation to facilities that are friendly to cash pay strategies".

You might say, "but wait, I pay a LOT in premiums so that insurance companies will pay claims"

I say, "exactly, if you will engage with me, I will show you the error in those thoughts and help you build a strategy where you don't need those insurance companies to pay claims".

Pro tip -- understanding that what you thought was an insurance company is actually not that at all. They don't even call themselves insurance companies anymore. Read their fine print. They identify as "healthcare services organizations". That means that they believe their main job is vertical integration. Not providing insurance.

Wendell Potter's Substack from Wednesday gives you a bigger picture here -- https://healthcareuncovered.substack.com/p/battle-between-health-care-giants?utm_source=dailyinsurancereport.beehiiv.com&utm_medium=newsletter&utm_campaign=daily-industry-report-october-24&_bhlid=e3d478ea3155625ddc8fba24b39c8e388d713fb4

Enjoy!
.ixable

Hundreds of Tenet facilities may leave Cigna’s networks over pay dispute.

04/01/2025

https://www.youtube.com/watch?v=Fbft1Jc9GNk&t=3885s

2025 is the first year I feel like I've stuck to a New Year's Resolution. Thank goodness I picked something I'm passionate about. No, it wasn't losing weight or eating healthily, although I need to do that too. This year, I resolved to attend my local Board of Commissioners meetings and sign up for the 3-minute public comment period to share insights that might be helpful from a public health standpoint. So far, I'm on track.

In March, the subject I chose to highlight was the "MDL" or multi-district litigation against certain drug manufacturers and pharmacy benefits managers, who pleaded "no contest" to allegations of price fixing, supply chain manipulation, and other shady practices. Big pharma has been suspected of inflating the price of life-saving prescription drugs like insulin and others; now it's our turn to hold them accountable.

Below are my comments regarding this topic if you care to listen. My comments begin at the 1:40:52 mark.

Please send me a message if you'd like to learn more about your rights as a plan sponsor and how you may also join the MDL to recover the plan assets that were illegally taken from your health plan by these bad actors. It is the responsibility of the plan sponsor to actively seek restitution for your health plan's members. They are counting on you to recoup their health funds so those monies can be used down the road when future health needs arise.


Bentley Main Street Family Medicine Shane Purcell

10/17/2024

Cool, kids in science class need to see this…

10/09/2024

https://www.visualcapitalist.com/which-countries-are-the-healthiest-in-2024/. Kinda disappointing that with the amount of money we spend on healthcare that the US doesn't have the highest score on the list. Our biggest problem is that we don't purchase healthcare prudently as we are required to under the Consolidated Appropriations Act of 2021.

Employers do have a role to play here. Engaging in a fiduciary process to prudently purchase healthcare options is a new way of looking at your employee health plan. I talk about this a lot on my podcast, Healthcare Solutions. I hope you'll subscribe -- https://www.custombenefits.work/podcast.

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10/07/2024

https://youtu.be/42lwi5-FXGM?si=Gw9qGgqPcO6NKECZ. It doesn't matter which political party you belong to. Healthcare transparency is a bi-partisan issue. Period.

To Every Elected Official and Politician in America,Workers, unions, and employers stand unified against the American healthcare system, which hides its pric...

09/19/2024

https://dpcnews.com/uncategorized/ill-fly-away/

I'm a little teary-eyed as I type this, but THIS (the article linked above) is what it means to take care of your patients. I attend many conferences, some where I speak to the audience and some where I'm learning from others as I sit in the audience.

When I hear physicians talk about "taking care" of their patients it always moves me, because what that means to (direct primary care) doctors is always a different picture of what it means when you have to practice under a fee-for-service model where insurance companies or the government stand in between the sacred doctor-patient relationship.

If you're a physician relying on insurance payments to take care of your patients, you need to hear this -- NOW is the time to start moving in the direction of direct primary care. Communities all over America need good doctors, especially the ones who know how to truly care. The demand is greater than the supply right now. You need to rise up and meet that challenge.

Reach out to any of the awesome DPC doctors linked here...they can show you the way. Shane Purcell Douglas Farrago Lee S. Gross Vance Lassey Geetu Goyal Ben Aiken Tanner Moore Matthew Kramer

The man on the right in this picture is Gary. His daughter gave me permission to share this story.   Gary was one of my favorite patients and a good friend. This picture was taken du…

09/19/2024

My opponent is misrepresenting the rate filing process to consumers for political purposes. Is she doing it out of ignorance or dishonesty? I don’t know, but either way, she is not acting in the best interests of the people of NC.

09/04/2024

https://www.benefitspro.com/2024/08/30/employers-turning-to-direct-contracting-amid-rising-health-care-costs/?kw=Employers%20turning%20to%20direct%20contracting%20amid%20rising%20health%20care%20costs&utm_position=1&utm_source=email&utm_medium=enl&utm_campaign=benefitsbroker&utm_content=20240904&utm_term=bpro&oly_enc_id=5912I2576489J3Y&user_id=5c5da476d165e1e09bf45d646072d6f43fd870d5fb2493e67ab57c4b078dbbaa&slreturn=20240904112809.

The outcomes are real! Stop worrying about health plan innovations not working. Worry more about your broker who might resist sharing these exciting innovations with you for fear that they might lose year-end bonuses. It's better to be working with an advisor. "All it takes is a good advisor and a little courage" -- someone who wants to help you succeed (that would be me) 😉

Direct contracting doesn't have to be the enigma you're making it to be. With the help of a good advisor, it's not hard.

Send a message to learn more

09/01/2024

Hard work, dedication and service to others are hallmarks of our communities. For those who put on boots, hats, coats, etc. and go to work, we say thank you! For those who would work if they could, please accept our outstretched hands in service to you, our brothers and sisters.

Communities need each other. Neighbors helping neighbors. That's just one of the things we're focusing on at Custom Benefits Solutions... with community-owned health plans.

This let's put our best thoughts into what we can do to foster the efforts it takes to develop community-owned health plans. We CAN do this!

08/30/2024

https://www.custombenefits.work/news/2022/8/27/mfb2mk0ta5q7e9o4tm2it2dleo986h-c4zkd-zdkba-55c8z-fp959-74xzg-gdaae-9tjpt-ay2j3-d3xlh-t3d8s

It's not headline news that America is experiencing a workforce crisis. Some in our workforce need a little extra help to stay productive while they also deal with complex disease. Let's think about how we view employee productivity and include our fellow workmates even when complex disease enters