Frustration of Fraudulent Claims

Folder with close up on the word claims and a note where it is written under investigation. Concept of insurance fraud, 3d Illustration

It’s a well-documented reality across nearly all lines of insurance coverage that fraudulent claims account for 5–10% of total claims processed. And despite the industry’s best efforts to combat fraudulent activity, it’s largely accepted as a “cost of doing business” in the world of insurance. What has frustrated several of my self-funded clients however, is… [Read More]

Examining Multi-Tiered Networks to Minimize Premiums and Foster Consumerism

Examining Multi-Tiered Networks

As health insurance premiums, copays and deductibles become unbearable, we’re often faced with clients who feel completely out of options during renewal conversations. They don’t want to switch carriers, but are out of levers to pull in order to control costs. Now we’re seeing carriers step in with an interesting solution: multi-tiered networks that align… [Read More]

Is Healthcare Realigning the Deck Chairs on the Titanic?

Is Healthcare Realigning the Deck Chairs on the Titanic?

It has been widely rumored that the Kentucky based insurer, Humana, is ripe for a transaction. Fueling the speculation is Humana’s poor performance of their public exchange products, suppressing profitability in the past year. Coupled with their significant Medicare Advantage members, they become an attractive target for the remaining national players. Anthem would be the most… [Read More]

Healthcare Bills in New York – No More Surprises


The consumer protections of New York’s “Emergency Medical Services and Surprise Bills” law go into effect on March 31st of this year. This law provides needed insulation from unexpected and previously unavoidable bills from out-of-network providers. One of the more frequent billing complaints I have addressed concerns out-of-network providers that bill for services performed during… [Read More]

Providers and Reimbursement: Continual Cost Changes Ahead


The healthcare industry is truly being shaken at its roots. I attended a New York Broker Advisory Council meeting with Empire BCBS the other day. I knew that hospital consolidation was happening, but I was really surprised to hear that there were 14 hospital realignments in the past year in the New York City market…. [Read More]

Strap In for Questions: EOB Can Be More a Complication than an Explanation of Benefits


Let’s put aside all of the ACA talk for a moment and focus on another challenge facing employee benefits: the complexities in interpreting an Explanation of Benefits (EOB). After all, with so many people anticipated to be covered, it’s crucial to understand the statement that explains how the insurance plan processes the charges. One of… [Read More]