What is the cost of prior authorization for employers?
Prior authorization (PA) is a utilization management tool designed to ensure medical services are clinically appropriate and cost‑effective. For employers,...
Claims & Appeals
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Prior authorization (PA) is a utilization management tool designed to ensure medical services are clinically appropriate and cost‑effective. For employers,...
Surprise medical bills are not just a headache for employees-they are a direct drain on employer healthcare budgets. When a patient unknowingly receives...
For years, ERISA health plan reporting felt like a dusty annual ritual. Your TPA would drop a Form 5500 on your desk, maybe a Schedule A, and you’d check...
Out-of-network (OON) charges represent one of the most volatile and poorly controlled cost drivers in employer-sponsored health plans. Unlike in-network...
Pharmacy benefit managers (PBMs) are the often-unseen architects behind your employees’ prescription drug coverage. They sit between employers, health...
A colleague of mine spent the better part of a year designing a value-based insurance plan that would have made any actuary weep with joy. Zero-dollar...
Every year, a benefits team somewhere sits around a table, opens a thick actuarial report, and tries to divine the future from claims that are already 18...
Every year, I watch benefits teams chase the latest shiny object-a new point solution, a rebate tweak, a wellness challenge that promises to get people...
Tucked inside every employer health plan’s claims warehouse is a damning report nobody runs. Open a folder of last year’s professional claims, lay it beside...
A 900-life employer I worked with recently learned a lesson the hard way - to the tune of $105,000. An employee's dependent needed a complex spinal fusion....
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