The Softening and Widening Stop Loss Market

Vintage processing of an open for business sign in small town America.

For the last several years, we’ve highlighted the dramatic market trend of employers adopting self-funding and the rationale supporting the move. As premium dollars have left the insured medical market, lots of those dollars have moved to the reinsurance markets with employers offloading the tail risk associated with their self-funded arrangements. Meeting the demand have… [Read More]

Insurers and PBMs Taking Action on Opioid Abuse 

Opioid health risk and medical crisis with a prescription painkiller addiction epidemic concept as a group of people running away from a dangerous falling bridge of pills as a medicine addict problem with 3D illustration elements.

Pharmacy Benefit Mangers (PBMs), which run the drug plans for health insurers, are paid on the volume of drugs they sell and have been criticized for lack of transparency and focus on profits. Likewise, health insurers are generally focused on controlling claims costs and don’t fully consider the effects of their decisions to limit access… [Read More]

Insurance Carriers Reducing the Cost of Care

Man at the table fills in the form of health insurance. Healthcare concept. Vector illustration flat design style. Life planning. Claim form. Medical equipment, money, prescription medications.

This week I am attending the Cigna National Producer Advisory meeting. I am pleased to say that Cigna, as well as all the national insurance carriers, are busy moving forward the goal of reducing healthcare costs by aligning interests. Physicians will receive additional compensation if results establish quality care, a favorable member experience and affordability… [Read More]

2017 Kaiser Family Foundation Survey Results

medical cost, stethoscope on dollar banknote money. concept of health care costs, finance, health insurance fund.

Kaiser has just published its 2017 annual benefits survey and I think the folks in Washington, D.C. all need a copy. Approximately half of the United States’ non-elderly population gets healthcare coverage through their employer, so this survey reveals what many Americans are experiencing. While employer coverage is far better, in many respects, than the coverage… [Read More]

Healthcare Reform… More of the Same

Healthcare in the Trump Era Takes Its First Step

The Senate is making one last-gasp effort to repeal ACA… Well, not actually repeal, just reconfigure. Lindsey Graham and Bill Cassidy have sponsored a bill, which will be eligible for consideration under budget reconciliation rules (i.e. 51 votes required to pass and not subject to filibuster). Under the bill the amounts paid by the federal… [Read More]

Reviewing Contracts: An Essential Part of Health Plan Management

Reviewing Contracts An Essential Part of Health Plan Management

And you thought it was tough to decide on plan design, communication strategy and contributions for your medical benefits plan… Once the crush of implementation begins, the plan documents will start coming to your inbox and it’s critically important that you understand them completely. The obvious first steps would be to check the principal plan… [Read More]

Another Blow to the Healthcare Exchanges as CareConnect Shutters

No Easy Answers Another Blow to Healthcare as CareConnect Shutters

CareConnect, the upstart insurance company founded in 2014 by Northwell Health in the Downstate New York marketplace, has made the decision to cease operations. It made a lot of sense that Northwell, a hospital chain with extensive provider connections, could cut out the middleman insurance company and offer insurance protection directly to its customers. It didn’t… [Read More]

The Frustration of Out-of-Network Billing

The Frustration of Out-of-Network Billing

Do your employees understand all of the implications of receiving out-of-network treatment? Even when a plan provides out-of-network coverage, your employees may find themselves paying out-of-pocket for a lot more than they anticipated. As supervisor of our Benefits Help Desk service one of the most common inquiries or complaints I hear is from upset employees who’ve… [Read More]