Is the industry seeing any resolution with inaccurate and fraudulent health claim billing?

Unfortunately, the health care industry has long been plagued by widespread issues of mis-billing. Think about it for a minute. How often do we see reports of extreme overcharges in the news that have us gasping at the thought of being billed hundreds of dollars for something as simple...

Sep 30, 2019

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How can benefit plans gain some control over the high cost drivers in health care?

This is an age-old question that we’ll probably be asking for years – decades even – to come. But before we tackle the how, I think we have to first consider the what … as in “what’s driving costs so high?” A recent report from Milliman sheds some light on...

Jun 27, 2019

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What can employers do to be part of the solution in addressing health care waste within their benefit plans?

It’s been reported that health care waste carries a price tag of $750 billion in the U.S. each year. That’s an outrageously expensive problem, isn’t it? And while employers who offer health plans across all industries seem to be aware of the issue, there’s not a lot being done...

Apr 25, 2019

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Why is medical necessity a factor when reviewing health claims?

As employers work to get more control of the health plan dollars they’re spending, closer claim review has become a key strategy. Medical necessity factors into this as it’s one area where excess spending is occurring on a regular basis. Unfortunately, in today’s society, there’s a trend toward overutilization in care:...

Jul 12, 2018

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Where could we be missing some savings opportunities in our company’s health plan?

When employers take a closer look at their health plans and break down the various elements, the savings opportunities start to become more obvious. In doing a broader analysis, here are three areas I’d like to point out. Health Claims – With a self-funded plan, employers pay only for the health...

Jan 10, 2018

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When reviewing health claims, do only the ones that total large dollar amounts need closer scrutiny?

The way we have always approached this at Cypress, each health claim should receive careful review. Sure, it’s not as likely that you’ll uncover huge savings with claims that amount to $1,000 vs. $10,000 or more – but every dollar adds up, especially over the course of a year. Some companies...

Aug 30, 2017

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1 min read

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In reviewing two separate health claims for the same MRI procedure, how can the charges be so drastically different?

We see cases of this all the time. The same procedure is performed at two different locations (sometimes within just a few miles of each other), but the health claim charges are outrageously different. It’s the result of the tremendous lack of transparency in health care. Unfortunately, this pricing variation can...

Mar 15, 2017

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Compared to traditional health plans, how is the claims review process different in self-funding?

With a self-funded plan, employers aren’t cutting a check for the same amount every month to cover health claims. Instead, the total they pay is based on how much their member claims actually add up to on a month-by-month basis. This creates a lot of incentive for them to take...

Feb 28, 2017

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With self-funding, what happens if a plan participant incurs an unexpected, high-cost claim that could break the bank?

This is where stop loss insurance comes in as a risk management tool for self-funded plans. It doesn’t insure your plan participants directly, but instead, stop loss insures the plan or plan sponsor (this is oftentimes the employer) from losses that could be catastrophic. Here’s a hypothetical scenario. Company XYZ’s workforce...

Nov 09, 2016

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What are peer independent claim reviews and when are they needed?

Let’s back up for a minute. One of the ways that self-funded health plans administered through Cypress differ from many fully insured plans traditional carriers offer is the thorough review process health claims go through. We don’t just take a quick process-and-pay approach; rather, we fully scrutinize claim charges on...

Jan 12, 2016

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1 min read

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