Archive for August 2nd, 2013

Stop Loss Carrier Sees Multiple Cost Plus Vendors Popping Up

Friday, August 2nd, 2013


We received an email this morning from a stop loss carrier we know:

“I left a voicemail on your cell phone a few minutes ago; I’d like to get your advice regarding Cost-Plus vendors……….there seems to be more such vendors popping up so I’m wondering if you have any insight on the new guys.”

This is another indication that Cost Plus, or Referenced Based Pricing is rapidly gaining market share.

Editor’s Note: We have compiled a listing of vendors actively engaged in Cost Plus / Reference Based Pricing – to be published soon on this blog. If your company wishes to be listed, please reply to


Who’s On First?

Friday, August 2nd, 2013


By Molly Mulebriar

Having nothing better to do this morning, I went back  through my medical / insurance records just to see how much I ended up spending out of my pocket over the past 12 years.

I have maintained a high deductible plan all those years through Blue Cross. My annual deductible is $10,000, after which the policy pays 75% up to a maximum out-of-pocket limit. I like the plan, and I have always been willing to assume part of the risk.

During this 12 year period, I had occasion to use the policy for a major health condition. Three in-patient hospital stays, a 5 hour surgical procedure, two trips to emergency room treatment, numerous follow-up visits with various specialists, and now check-ups every three months.

My out-of-pocket totaled $52,000. My insurance premium was $60,000, bringing my total cost to $112,000. If I had no insurance at all, my total cost would have been $80,000, or $33,000 less than it cost to have the insurance policy.

It would appear that the insurance company won, and I lost. But the truth is Blue Cross lost money on my policy in this instant. So that must mean I won, the insurance company lost. But wait, I could have saved $33,000 without the policy! So I lost! If I lost, Blue Cross must have won! But Blue Cross lost too! So Who won?

Actually, I have no complaints at all. Insurance is a risk transfer strategy used to indemnify against unexpected, catastrophic losses.  I would have been happy to have had no losses the past 12 years  in exchange for $60,000 in insurance premiums.

Editor’s Note: Molly Mulebriar is a forensic auditor/investigative reporter from Waring, Texas and a frequent contributor to this blog.