The Network Adequacy Trap
Most people think network adequacy is a simple math problem. Regulators draw circles on a map: one primary care doc per 2,000 members, a specialist within...
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Most people think network adequacy is a simple math problem. Regulators draw circles on a map: one primary care doc per 2,000 members, a specialist within...
Let me paint a picture you’ve probably lived a dozen times. The renewal spreadsheet lands on your desk, and within seconds all eyes lock onto a single...
At first glance, mental health parity laws like the Mental Health Parity and Addiction Equity Act (MHPAEA) appear to be a straightforward compliance...
A few years ago, I sat across from a CFO who couldn't understand why his stop-loss renewal had jumped 32%. His claims experience was flat. No new high-cost...
Every few years, a consultant walks into a benefits meeting and promises that reference-based pricing will slash your health plan costs by 40 percent...
The short answer is yes, employer health coalitions can and do negotiate lower healthcare costs -often achieving savings that individual 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...
Out-of-network (OON) charges represent one of the most volatile and poorly controlled cost drivers in employer-sponsored health plans. Unlike in-network...
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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