The Hidden Cost of Reference-Based Pricing Nobody Talks About
You’ve heard the pitch: reference-based pricing slashes healthcare costs by paying a fair multiple of Medicare, bypassing bloated networks, and saving 20 to...
Claims & Appeals
520 posts
You’ve heard the pitch: reference-based pricing slashes healthcare costs by paying a fair multiple of Medicare, bypassing bloated networks, and saving 20 to...
Every renewal season, you do the same dance. You pull claims reports. You benchmark against similar groups. You brace for the trend curve. And you haggle....
The short answer is: potentially significantly, but with important caveats. Employee wellness incentive programs, when designed and implemented...
Every fall, it's the same scene. You sit in a conference room, someone clicks to a slide that says "Projected Medical Trend: 7.5% to 9.0%," and everyone...
Artificial Intelligence is rapidly transforming employer-sponsored healthcare from a reactive, cost-intensive system into a proactive, value-driven one. Its...
If you run a self-funded health plan, you know the drill every year. You send your stop loss carrier a stack of claims from the past 12 to 18 months. They...
You've done the hard work. You've benchmarked your TPA fees, audited your PBM contract, and reviewed your stop-loss policy. Your fiduciary checklist is...
Most benefits leaders think they know what COBRA administration costs. It’s that line item on the vendor invoice-a few bucks per participant per month. But...
You signed a contract promising 100% prescription drug rebate pass-through. Your CFO smiled. Your consultant nodded. And a few months later, the check...
You’ve done the fiduciary training. You’ve reviewed the investment menu. You’ve filed Form 5500 on time. You’re compliant, right? Not so fast. There’s a...
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