What is the impact of high-cost claims on employer healthcare costs?
High-cost claims are the single most significant driver of volatility and long-term expense in employer-sponsored health plans. While routine primary care...
Claims & Appeals
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High-cost claims are the single most significant driver of volatility and long-term expense in employer-sponsored health plans. While routine primary care...
Healthcare pricing transparency is a powerful but often underutilized tool for employers to reduce costs. At its core, it means providing clear, accessible...
A few months back, I sat across a conference table from a benefits director who was beaming. Her team had just completed a repricing vendor RFP, and the...
Picture this. It’s the last week of the month. Your finance team pulls a number out of the system-total benefits spend divided by total covered...
Let me tell you a story about a well-meaning employer who thought captive stop-loss would be their financial salvation. The pitch was perfect: form a...
A few years ago, I sat in a conference room watching a benefits director scroll through her enrollment platform. She was proud of the sleek interface-plans...
When we talk about healthcare cost containment in employee benefits, the conversation almost always lands on network discounts, drug rebates, prior...
Reference-based pricing (RBP) fundamentally alters how employers pay for healthcare by shifting from a traditional percentage-of-billed-charges model to a...
Mental health parity laws, primarily the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and the Affordable Care Act (ACA), require that...
You dodged the penalty. Kept your headcount under 50. Filed the right codes on your 1094-C. The IRS isn't coming after you. Feels like a win, right? But...
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