Nov 27, 2023 | Case Studies, Claims, Claims negotiation, Cost Savings, Forensic claims review
A MedBen client realized an overall savings of 62% through repricing, forensic claims review, and provider negotiation. The client in question received a claim for IV infusion to a member with iron deficiency. After the PPO discount, MedBen saw an opportunity to...
Sep 5, 2023 | Alternative Reimbursement Strategies, Claims, Comparative Effectiveness, Cost Savings, Direct-to-Employer Contracting, Drug costs, Fair Market Pricing, Forensic claims review, High-cost claims, Inflation, MedBen Rx, MedBen WellLiving, Reference-Based Pricing, Rx Costs, Savings, Self-funding, Specialty Care, Survey, Wellness
A new survey by International Foundation of Employee Benefit Plans found employers expect plan costs to increase seven percent in 2024. As to why, they gave a range of answers, with the top four reasons representing 71 percent of responses (see chart below). As it...
Aug 21, 2023 | Claims, Fraud, MedBen Rx
The Texas Attorney General’s Office recently announced the recovery of $42.7 million in taxpayer funds… the result of enforcement action against six pharmaceutical drug manufacturers alleged to have committed fraud. The companies’ violations included...
Aug 8, 2023 | Cancer, Chronic conditions, Claims, Cost Savings, Heart, High-cost claims, MedBen WellLiving, Savings, Stop-Loss
Cancer and heart disease account for 37% of total stop-loss claim reimbursements over the past four years. This demonstrates once again the importance of a wellness program to catch chronic conditions, and reduce the risk of high-cost claims, at their earliest stages....
Jun 14, 2023 | Claims, Demographics, Out of pocket, Reporting
Million-plus dollar claims continue to increase… and not just from older plan members, according to a new report by the National Alliance of Healthcare Purchaser Coalitions (NAHPC). “Employers are seeing a rise in high-cost claims for younger plan members, with...
Mar 31, 2023 | Claims, Claims Management, Direct-to-Employer Contracting, Forensic claims review, MedBen University, Medical necessity, Roundtables
Contracting directly with a health system offers employers pricing control, member access to high-quality local care, and the flexibility to create multiple benefit options. At this year’s MedBen University roundtables, Regional Sales Director Brooke Hupp...
