Stop-Loss Pricing Starts With Last Year's Claims
KFF's 2023 Employer Health Benefits Survey found 65% of covered workers are in self-funded plans. Those employers pay claims directly. They buy stop-loss...
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KFF's 2023 Employer Health Benefits Survey found 65% of covered workers are in self-funded plans. Those employers pay claims directly. They buy stop-loss...
There is no fixed statutory price for mental health parity compliance. The cost depends on four factors: how many mental health and substance use disorder...
Employers that track where surgeries happen can cut their healthcare spend by thousands of dollars per case. The price difference between a procedure...
Most employers that adopt reference-based pricing spend months preparing for provider balance bills. They negotiate hold-harmless language with repricing...
A hospital stay in December. The bill lands in February. The old stop-loss carrier says “no” because the policy ended at midnight on December 31. The...
A company that sponsors a self-funded health plan becomes a fiduciary the moment the plan document is signed. Most employers understand this means watching...
An employee at a mid-size manufacturing firm needs a routine hernia repair. She checks her insurance network, finds an in-network surgeon and hospital, and...
Your broker hands you the year-end stop-loss report. Paid claims land well below the attachment point. The numbers say you are due a refund. Five months...
The average cost of claims processing for a self-funded employer health plan runs roughly $25 per employee per month, or about $300 per year, based on the...
A growing number of self-funded employers are being named in lawsuits by their own employees, and the root cause is a cost-control strategy that promised to...
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