Stop Loss Claim Nightmare

Busy Jill – She Had 18 Children In Less Than 10 Years

Not too many plan sponsors have ever conducted health plan dependent eligibility audits leaving them at risk of stop loss claim denials. If Little Johnny is the covered employee’s nephew, with the same last name, has a stop loss claim you can rest assured the stop loss carrier will determine they are not at risk leaving the plan sponsor eating the entire claim……………A ticking time bomb waiting to happen…………….

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“Healthcare is the only expense line item in which all employees receive an unlimited budget…and also no training in how to spend it. That’s why they sign up for $2500 procedures when a $75 solution would do the trick.”  – Dave Chase

Reduce Healthcare Costs by Offering a ‘Free’ Option

If you had a group of employees traveling on a business trip and you told them they’d only need to pay a $100 contribution toward the hotel room, what’s to stop them from choosing a Ritz Carlton over a Days Inn? Both provide a decent night’s sleep, but one will cost you, the employer, a significant amount more.

This is what manufacturing firms are doing now with their benefit plans

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Aetna Touts Cheap “I-35 Discount Providers”

Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.

“Holy Smoke guys, we’ve singled out our cheapest providers,  much cheaper than all the others,  20% cheaper! We call it the  I-35 Performance Network.” says the Aetna rep.

“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”

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