- Employee frustration with medical claims processing
- Large consumer of staff time
- Health plans are not simple
- Insurer/administrator should have the solutions — but often not the case
- Need to know how plan interfaces with other company programs
EMPLOYEE PERSPECTIVE
Have you ever been frustrated by how medical claims are processed? Have you or your staff spent hours trying to resolve medical claims for employees? Has your costly health plan received negative comments from the very people it’s supposed to benefit?
Health plans are not simple to understand, or to administer. Complicated “terms” enter into the process...
- Deductibles - annual, carry over, per employee, per family, per diagnosis
- Co-Pays - percentage or flat amount, per provider
- Preventative care - frequency, per procedure, age/gender
- Participating/Non Participating - providers change annually
- Maximum Out-of-Pocket - annual, lifetime, per diagnosis, per procedure
- Co-Ordination of Coverage - spouse plans, primary/secondary, automobile coverage
- Prescriptions - Generic/Name brand, co-pay differences, no coverage
- Flexible Spending Accounts - pre-tax, estimates for future, “use it or lose it”
- HAS/HRA - insufficient funds, debit cards, bank reconciliation
- Excluded Coverage - seems unending and in the 'fine print'
...and the list goes on.
EMPLOYER PERSPECTIVE
As the employer you’ve done your part. But are you getting the value for your investment? If the employee has to struggle to get what you gave them, they may feel the value is limited, or that the plan is marginal. Furthermore, Medical Claim Resolution (MCR) is a substantial consumer of staff time a company encounters, and it’s not directed at enhancing your business goals. Even the most conscientious employee can get caught in spending ‘your’ time on personal MCR. You have to track down the answer when the billing office or the insurance company is available. That is during ‘your’ business hours. This is why the employer should be concerned.
Perhaps the agent who sold you the health plan, or the insurer/administrator that processes claims should have the solution, but this is often not the case. Unfortunately many agents, insurers/administrators only know how their plan works and not how it interfaces with other programs. Many families have both spouses working, children covered by a prior spouse, or by a government program; often there are multiple plans in place and resolution gets very complex. It takes time to sort things out, ‘your’ time.
THE SOLUTION
At P3 our staff has experience with understanding how it all fits together. We have designed comprehensive benefit programs for large and small organizations. We know the ‘language’ and how to ask the right questions to get MCR efficiently taken care of; we get it done quicker, and in the long run, a lot less costly. We can free up your staff to take care of enhancing your business and employees will like and value the benefits you gave them better.