Smaller Companies Move to Self-Funding

Many expected that the federal health law would push these employers in this direction. An analysis by the Employee Benefit Research Institute finds evidence that these predictions are coming to fruition.

Instead of buying a health insurance policy to cover their workers, a growing number of small and mid-sized companies are opting to pay their employees’ medical claims directly, a potentially riskier practice financially called self-insuring, a recent study found. more

We Call Them ‘Zero Balance Claims’

by Ryan Jerico
Senior Consultant, TFG Partners

With my Prescription Benefit, I pay a $20 copay for all generic medications. So when I go to the doctor for my yearly sinus infection each spring, things are pretty routine. She writes me a prescription for Amoxicillin.  I walk across the street into a large chain grocery store who advertises $4 for a 30 day supply of 40 different generic drugs. more

Plan sponsors being sued, Personally.

by Ryan Jerico
Senior Consultant, TFG Partners

Truthfully, this is not an “I told you so” situation, but…. look at Dave Chase’s piece in Forbes and well….

For many years TFG Partners has been providing clients with in-depth audits via our 100% methodology. These medical plan claims audits routinely uncover issues of Other Party Liability, Duplicates and Coding issues and Plan Benefit compliance.. While there can be significant savings from correcting these administrative weaknesses, uncovering issues surrounding provider contracts, administrator policies that conflict with the plans’s benefits documents and intent, and shifting numbers in calculations to meet discount/performance guarantees has always been particularly troubling to us as auditors. Most of the time, our clients have shared our concerns and moved forward to have these issues corrected and recover dollars to the plan. We have also seen plan sponsors fail to act on the information presented.

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