Emergency Room Claims – Self-Diagnose or Pay the Price?

An emergency department sign.

While most of us know that emergency room (ER) care is more expensive that non-emergent care, you may not have realized just how much more. In some cases, you could be responsible for the entire cost of your hospital ER visit. We’re hearing an increasing number of stories from patients who are being billed for the… [Read More]

Anthem Gets Tough with Hospitals

Anthem Gets Tough with Hospitals2

One of the greatest frustrations our self-funded (and to a lesser extent, fully-insured) clients voice is that – despite the hundreds of thousands or millions of dollars they pay the insurers to assist in managing their health plan spend – too often it appears the insurers are complicit in the rising healthcare spend by not… [Read More]

A Look at Catastrophic Claims in the World of Stop Loss

thinkstockphotos-492819289

Sun Life Financial recently released a report on the top ten claims conditions which give rise to stop loss claims under a self-insured healthcare plan. Sun Life analyzed four years of their catastrophic claims data and found that these ten claims represent 53% of all stop loss claims reimbursements. 26.6% of all stop loss claims… [Read More]

Controlling Specialty Drug Spending

Drug Cost  Specialty Pharmacy

Another commentary from the National Blue Cross Consortium. As I mentioned in prior posts, large claims are on the rise. Last year, Blue Cross paid their first individual claim for more than $15M, and the frequency of claims over $1M tripled from 2010 to 2015. Specialty medications are a real focus area. There is a… [Read More]