During a routine analysis of a client’s existing plans, we found that their lowest compensated employees were selecting the plan with the highest payroll contributions. Even though these members were not high utilizers of the plan, employees were contributing over 50% of their salary toward their health benefits.
In our experience, this was due to lower-compensated employees fearing that they would be unable to sustain a large deductible expense should they or a family member experience a significant health issue. We, therefore, introduced an HRA (Health Reimbursement Account) funding strategy based on compensation that would allow lower-compensated employees to enjoy lower premiums without the risk of high out-of-pocket medical expenses.
For a self-funded client, we found a nearby Imaging Center that offered significantly lower radiology costs than professional centers in the area. With the Center’s assistance, we reprocessed a year’s worth of radiology services for the client.
If their employees had utilized this facility for outpatient radiology services, it would have resulted in a savings of approximately $75,000 in claims. We, then, structured the plan design to incentivize use of this Imaging Center for the next plan year, where employees would experience a 50% decrease in the copay for radiology services – ultimately ensuring cost savings for all parties.
A client’s employee was involved in a clinical trial due to the relapse of a serious medical condition. Because the provider and facility associated with the trial were designated as out-of-network, the employee received an initial invoice in the amount of $179,000.
Through our advocacy, we were able to get the invoice reduced to $27,000 and ensure all future trial-related services were deemed in-network, substantially reducing the out-of-pocket costs to the employee. This was accomplished by diligently working the appeals processes with both the provider and the carrier.