Employee Health Plan Savings
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Program Overview
- As healthcare costs continue to rise and consumers are more often expected to pay exorbitant bills, the need for alternative benefit plan solutions is more important than ever.
- Employee health benefits are often the second largest expense for employers, just after payroll, and according to surveys, controlling that cost is the number one issue, or problem employers are facing today.
- The Cost of Health Care for employers and their employees, is growing at an unsustainable rate, rising faster than inflation, workers earnings, GDP, and profit margins.
- Less than 30 years ago, family health coverage cost just $200 per month, now the cost to insure the same family is over $1,600 per month. The average family health insurance premium now exceeds the average monthly mortgage payment.
- While the cost goes up, employees are often having to take on a larger portion of the cost of coverage; and, while employees are having to pay more for coverage, they’re seeing their out of pocket costs increase as well.
How it Works
You can establish the multiples of the Medicare fee schedule your health plan will pay.
A good Reference Based Pricing (RBP) administrator will contact doctors and other medical service providers utilized by your plan participants at plan inception. Coverage, coding values, eligibility and verification that your plan participant’s new plan is noted in the medical provider’s computer.
RBP balance billing problems occur with about 2% of all claims using a good RBP administrator. This is about the same percentage as a PPO plan with hospital-based physicians: anesthesiologists, radiologists, pathologists and emergency department doctors who are not in the PPO network.
RBP repricing vendors provide legal advice and assume health plan fiduciary responsibilities on problematic claims.
Health plan has flexibility to incent utilization of high-quality, low-cost providers. When needed, health plan can negotiate unique payment arrangement with a specific medical provider.
RBP requires more time and labor by HR department and administrator. Because employees must be educated on plan usage for the best results, some benefits advisors will advocate for the status quo to avoid the extra work. However, the value to the company and employees far outweighs the extra work.
Some medical providers may demand payment at the point of service. Alternate providers and one-time payments can be applied to mitigate disruption.
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Specialized Consulting: Managing Health Benefit Costs and Enhancing Care Quality.
We save you money, or you don't pay.
It’s that simple.
Platinum Savings Group provides tailored solutions that meet your specific needs.