Pharmacy Benefit Carve Out

More employers are choosing to "carve-out" the pharmacy benefit of their health plans. Prescription drug coverage is the most utilized healthcare benefit, trending annually at 15% to 25%. Pharmacy costs represent nearly 30% of total healthcare dollars. As these costs continue to rise, it is becoming increasingly important to proactively manage the pharmacy benefit. 

Why carve-out your prescription drug benefit to a pharmacy benefit manager? Cost containment. To better control pharmacy benefit costs, many employers separate or carve-out their prescription drug benefit from their major medical plan and contract directly with a pharmacy benefit manager, who is able to focus only on managing prescription drug costs. 

Virtual Health Clinic

 

Your family’s health is a priority.  What if employees could spend less on healthcare without compromising quality medical advice?  Virtual health clinics are designed to reduce employees out-of-pocket healthcare expenses at a negligible cost to employers.  Benefits can be wholly or partially funded by employer groups.

Telehealth

24/7 access to a doctor is only a call or click away—anytime, anywhere in the U.S. with no consultation fee. Now employees can talk to a doctor by phone or online video consult to get a diagnosis, treatment options and prescription if necessary. Employees save time and money by avoiding crowded waiting rooms in the doctor’s office, urgent care clinic or ER. Members use their computer, smart phone or tablet to get a quick diagnosis by a U.S. licensed physician.  Usage of these benefits are outside of the health plan thus reducing the amount of claims affecting renewal rates.

Doctors Online

The fast, easy way to get health information from an online resource you can trust. Members  have 24/7 access to doctors, pharmacists, psychologists, dentists, dietitians and more by email or smartphone app. Treatment options and advice that is easy to understand. With Doctors Online, the doctor’s always in!

Health Advocacy

Healthcare is becoming harder to understand. Personal Health Advocates (PHA) help employees find their way through insurance and healthcare systems. PHA's can also locate doctors, specialists, hospitals, dentists and pharmacies. Advocates research treatments, resolve claims and provide medical explanations so employees can make more informed decisions.

Medical Bill Saver

Major issues can add up to major bills! Skilled negotiators will attempt to negotiate discounts on members behalf, no matter the benefit status. Negotiations can lead to a reduction in out-of pocket costs.

Medical Claims Audits for Self-Funded Plans

How often does your TPA get you refunds from providers and/or credits from benefit overpayments? Due to the complexity of medical billing guidelines, it would be impossible for TPAs to scrutinize every claim your company receives. Through our partnership with best in class auditing firms your claims are analyzed in areas your TPA couldn’t possibly have the time, staff, and/or program edits to accomplish. Auditors typically find overcharges–and overpayments–that could result in savings of 3%-7%.

Ongoing plan monitoring can significantly reduce the total billed charges and identify erroneous, fraudulent, and abusive billing practices, reducing medical bills to “true and accurate” and “fair and reasonable”. 

 

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Southfield, MI 48034
248-663-1268 main
248-351-6001 fax