Archive for September 24th, 2011

Texas Firm Negotiates / Audits Health Care Bills

Saturday, September 24th, 2011

Austin Resolutions assists in claim management by negotiating / auditing health care provider bills. “Discounts from Billed Charges can be misleading…………..”

Editor’s Note: What has been their success with Seton?

Group Launches Medicare/DRG Based Pricing For Self Funded Employers Tired of PPO Discounts

Saturday, September 24th, 2011

           MyHealthGuide Source: H.H.C. Group, 9/20/2011,

Now there’s a better option than PPO discounts. H.H.C Group, a leading healthcare insurance consulting company, announced the launch of its Medicare/DRG Based Pricing Service, designed to help payors of all sizes reign in ever increasing provider related costs.


What’s A $1,000 Deductible Worth?

Saturday, September 24th, 2011

Rocky – Underwriter Whiz of PayLess Insurance Company

According to the American society of Actuaries, claim frequency and severity statistics show that 20% of any population base has annual medical expenses of more than $1,000.  A $1,000 annual deductible will be met by 20% of the group. That means 80% of the group will not satisfy their deductible during the year.

Removing the $1,000 deductible entirely will benefit 100% of the group  participants while 80% of the group will gain a benefit worth less than the benefit gained by 20% of the group.

According to the American Society of Actuaries 23% of any given population will not have any medical expenses during the year. That means 77% will. But 80% of those that do incur medical expenses will have claims below $1,000.

So what would it cost to eliminate the $1,000 deductible from a health plan? If everyone had medical expenses in excess of $1,000 during the year, the cost would be $83.33 pepm plus premium tax plus reserves. But that wont happen. An acturial chart used by many underwriters has a 9.1% load factor to eliminate a $1,000 deductible.

Eliminating the $1,000 deductible does not mean the exposure goes away or even increases. It’s a matter of allocating the risk, winner take all if fully-insured.