What a spring we have had here at The Phia Group. From travelling across the country speaking at various venues, hosting our own Phia Forum a few weeks ago, to our new service offerings; we have been extremely busy here at the home office. Now that the summer is here, you would expect that things would slow down but that’s not the case at all. As the temperature rises, so does our work load, as the number of issues facing the self insured industry continues to grow. Who said that health insurance is boring!?!?!?
As plan sponsors and administrators examine their benefit plans in light of recent legal upheaval, now is our chance to implement important cost containment mechanisms. While only some changes are “mandatory,” while the “hood is open,” why not look around and make some other improvements? First and foremost, but often forgotten, is coordination of benefits, third party liability and subrogation. ”Subro” is one item that must be set forth in writing, and flow cohesively between the plan, stop-loss, network, and administrative service agreement. How recovery efforts are handled, who gets what (and when), and other subro-related issues can tie the elements of a strong plan together, or create gaping chasms between partners.
While it is true that some network contracts restrict a benefit plan’s ability to audit claims – or as is more often the case, simply prohibits the benefit plan from doing anything with the information so identified; some contracts apply unrealistic deadlines and still others contractually compel payment of claims otherwise excluded by the plan document… There are key provisions plan administrators can use to limit or eliminate the negative impact of such provisions.