Over the past two decades, business leaders have faced significant challenges in controlling medical benefit plan costs. Recently, there has been a notable increase in the adoption of the dual-option model. The popularity of the dual option is rising as escalating premium rates make traditional health plans unaffordable for most working-class Americans.
September 2025 | Get the latest from the best RBP advocates and auditors
Industry Perspectives
Ben Krambeck
CEO
Dual Option: Cut Costs, Not Employee Satisfaction
Traditionally, the best of both worlds has been out of reach for employees and companies when it comes to health plan design. Plans designed exclusively by financial officers don’t always address employees’ needs, while plans managed solely by human resources sometimes fail to meet a company’s financial objectives. Fortunately, the landscape is evolving. In the employer-sponsored benefit plan sector, organizations are increasingly seeking solutions that balance both employee satisfaction and cost efficiency.
Over the past two decades, business leaders have faced significant challenges in controlling medical benefit plan costs. Recently, there has been a notable increase in the adoption of the dual-option model. This approach allows employers to offer both a BUCA PPO and a ClaimDOC reference-based pricing plan, giving employees the flexibility to choose their preferred plan. Typically, the RBP option features lower deductibles, reduced out-of-pocket maximums, and decreased paycheck deductions. The popularity of the dual option is rising as escalating premium rates make traditional health plans unaffordable for most working-class Americans.
Paying cash for healthcare services is not a new concept, but it’s also an option that is not widely used. The reason is because many providers prefer to accept reimbursement from insurance. But cash pay does have its advantages.
On this episode of ClaimTalk, Danielle Young visits with Amy Pellegrin and Leah DeBartolo about the pros and cons of cash pay, how health plans can create service around cash pay, and what stands in the way of cash becoming a more popular payment option for healthcare.
A blood glucose test is done to measure the amount of glucose in the patient’s blood using a reagent strip test method. Ancillary staff in a physician’s office or in a hospital typically collect the blood specimen for this test, using a finger stick and by placing a drop of blood on the reagent strip. After a brief period, staff compare the reagent strip to a color chart supplied by the test kit and determine the level of blood glucose by visual comparison or use the reagent strip with a glucose meter to obtain the blood sugar reading within seconds. Ancillary staff records or documents the test result in the patient’s medical record. This type of blood glucose testing is also frequently performed by patients when instructed in their home as part of diabetes self-management.
The current cost of reagent strips to assess blood glucose typically ranges from 40 cents to 70 cents per test strip. In this Audit Spotlight, we focus on the disparity of charges seen on healthcare claims for this frequently performed laboratory test. Read more.
DirectAccess+® Savings
DirectAccess+® clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. The audit team performs line-by-line claim audits to help clients and members maximize their savings. Below is one recent audit result showcasing substantial savings.
Hackensack, New Jersey
Five-day hospital stay for the treatment of a broken left hip prosthesis and related surgery
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.
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