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Combining Health and Pharmacy Benefit Administrators

company mergers are an opportunity to audit medical benefits and pharmacy claims. Auditing can also include continuous monitoring.

Can Merged Companies Better Reduce Health Costs?

Each year in the United States, health care costs increase. It’s something we watch every day at TFG Partners as we conduct medical claim audits. Rising costs are a budget issue for businesses, the government, and all of us as individuals. Therefore, the search is always on for ways to reduce costs. In the past couple of years, combining health and pharmacy benefit administrators was heralded as a way to do it. Yet a survey of corporate benefits executives found that only 50-percent had confidence it would work. The rationale from the combined companies is that cost-savings result when fewer entities are trying to earn a profit. CONTINUE READING

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Huge COVID Test Overcharges are Making News

covid testing overcharges that require your plan to get a medical audit and benefits assessment.

After a freestanding emergency room billed an Austin, TX, man’s insurance carrier $10,984 for a COVID-19 test, the case has come under scrutiny. Ironically, the man is a physician and had been on staff at the emergency care clinic. The case has gained widespread attention after the doctor left his job and reported the incident to the nonprofit investigative journalism organization Pro Publica. CONTINUE READING

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Making a Case for Monitoring COVID and All Claims

covid is dominating the headlines, we're here to help control the overcharges by medical insurance claims.

Rarely does an event occur that affects a company’s unexpected medical plan expenses as is the case COVID-19. The Kaiser Family Foundation estimates coronavirus treatment for the average patient without complications averages $9,763. If someone has complications, it doubles to a cost of $20,292. The Kaiser researchers arrived at the numbers by tracking and reviewing hospital costs of patients with pneumonia. CONTINUE READING

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Continuous Claims Monitoring Keeps Administrators Accurate

We audit claims and continuously monitor your company's medical benefits claims to make sure that insurance companies are not over-charging for prescriptions and benefits.

Self-Funded Plans Benefit from Continuous Monitoring.

There is enormous financial and plan performance value in continuous monitoring of benefit claim payments. When you entrust a health insurer or other administrator to process claims for your self-funded plan, you hand them an open checkbook in many regards. While much of what they do goes as expected, a surprising percentage falls outside of the agreed-on parameters. It means plan members (your employees) may not be receiving the most effective outcomes, and costs can rise needlessly.  Some of the processing abnormalities are inadvertent, and others may be more purposeful — because no one thinks you’re watching. CONTINUE READING

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