Why RBP Vendor Fees Reward Inflated Bills
A hospital sends a $6,200 bill for a knee MRI. Your reference-based pricing (RBP) vendor reprices it to $1,900. The vendor reports a 69 percent savings....
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A hospital sends a $6,200 bill for a knee MRI. Your reference-based pricing (RBP) vendor reprices it to $1,900. The vendor reports a 69 percent savings....
A renewal lands on your desk. It has a rate, a percentage increase, and a summary of last year's claims. The number reads like an invoice. It is a...
The premium increase sitting in front of you is an actuarial output built from paid claims that are months old, trend factors the carrier selected, and a...
Every employer wants lower claims. The medical loss ratio does not reward a carrier for delivering them. The medical loss ratio (MLR) rule requires a large...
Direct primary care sounds like a clean deal. The employer pays a monthly fee per employee. The clinic offers same-day visits with no copay. Nobody thinks...
Your stop loss underwriter knows which employees will drive next year's renewal before your benefits committee does. The renewal packet is where...
Most health plan audits stop at the claim. Employers and their third-party administrators pull paid claims, check eligibility against the payroll file, hunt...
A third-party administrator holds something more valuable than its call center scripts or its network discounts. It holds your plan's memory. Who enrolled,...
Employers run two health budgets that rarely talk to each other. Occupational health handles work-related injuries, fitness-for-duty exams, and...
A hospital now publishes the exact rates it negotiated with your health plan. Most self-funded employers have not opened the file. That is a chance most...
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