The DOC

Oct. 2021 | Get the latest from the best RBP advocates and auditors 

Industry Perspectives

Andrew Soha

Vice President of Business Development

The Illogic of Employer Health Plan Renewal Increases

Fourth-quarter has arrived, and brokers are once again negotiating with health insurance carriers on behalf of their clients to reduce renewal increases. Anyone who’s been in the industry for a few years knows this annual ritual. The carrier renewal letter arrives with a 12% to 15% rate increase with little or no reason for the increase.

BUCA carriers are getting less transparent with sharing claims experience data despite transparency-focused legislation by the federal government.  Most major medical PPOs and HMOs have a baseline annual premium trend increase of about 12%, not including demographic changes or claims experience. Providing a logical explanation of this number to brokers during my years as a BUCA carrier rep was as difficult as it was frustrating for me to hear the same explanation as a broker. Curiously, carriers readily reduce or back off the initial renewal offer simply by the broker presenting competitor offers. It’s almost as if the initial offer was a made-up number, especially when considering that Medicare’s pricing index has an annual trend increase of 1.6%!

Predictably, ClaimDOC clients have an average annual increase of only 2%. Let’s take a quick look at industry financials then break down the numbers. Read more...

Client Savings

Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.

1. Brooksville, FL

Hospital outpatient services for the treatment of varicose veins of left lower extremity

High-Dollar Services:

Operating Room: $46,981.50
Radiology: $17,447.25
Anesthesia: $9,456.50

Savings Summary:

Billed Charges: $90,215.89
ClaimDOC Allowed: $5,772.61
Plan Savings:$84,443.28
Reduction: 93%

2. Sylacauga, AL

Air ambulance services for the transport of patient with sepsis and respiratory failure

High-Dollar Services:

Air Ambulance Transport: $50,836.60
Air Ambulance Mileage: $10,577.82

Savings Summary:

Billed Charges: $61,414.42
ClaimDOC Allowed: $5,380.56
Plan Savings:$56,033.86
Reduction: 91%

Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies, and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.

Member Experience

Feedback from a Member

Brittany is my favorite Member Advocate. She is quick to respond and quick to figure out the solution if there is a problem. She takes everything off of my plate and puts it on her own. She works with providers and keeps me informed every step of the way. She is awesome! There are few people like her in the world, and I just can't say enough good things about her.

We've updated our website!

Whether you're an Employer, Provider, Broker, Stop Loss Carrier, or Member, get valuable information 24/7 by visiting claim-doc.com.

You received this email because you signed up on our website or made a purchase.