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State of the Union Spotlights Pharmaceutical Problem in America

by Christopher RoachFebruary 1, 2018December 4, 2019Leave a comment

Pharmaceutical companies’ stocks took a hit just after the State of the Union address, when President Trump listed drug pricing as one of his “greatest priorities” this year. Medication prices across the board have been rising sharply, occasionally with consequences from Washington.

For example, Turing Pharmaceuticals former CEO Martin Shkreli was called to appear before Congress when he raised the price of the AIDs medication Daraprim from $13.50 per pill to $750 per pill in 2016.

There have not yet been any policy initiatives to force drug prices down, and until there are, prices are likely to continue to rise — with insurance companies finding more ways to pass this burden onto you, the consumer.

One of biggest changes I’ve seen among my own clients is many medications have changed tiers, resulting in a much higher cost share for members. So a drug that was once in Tier 2 and covered with a $50 copay may now have switched to Tier 3 with a $150 copay — for the same drug at the same insurance carrier. That’s a pretty shocking price hike in a matter of just a few months.

I’ve also seen many insurance carriers adopt a Mandatory Generic Substitution for a growing number of medications. This requires members only receive the generic version of a drug, or pay the difference for the brand name version.

Then some drugs have fallen off of insurance carriers’ formularies altogether, meaning they are no longer covered at all. Most often this happens when a drug has become so expensive even insurance carriers are having trouble paying for them. So imagine how the average consumer feels.

All in all, this is not a problem exclusive to 2018 alone, but it is a problem that will only get worse until sweeping changes are made to how drugs are priced. So please, Mr. President, make the drug industry great again.

An insurance shakeup? Three American corporations join forces to tackle healthcare

by Christopher RoachJanuary 30, 2018December 4, 2019Leave a comment

Amazon CEO Jeff Bezos, Berkshire Hathaway CEO Warren Buffett and JP Morgan CEO Jamie Dimon are joining forces to launch their own healthcare company, according to a press release today on Business Wire.

The goal of their new joint venture “is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans,” said Bezos.

But what does that mean for everyone else in the health insurance industry?

Right now — nothing. Aside from a quick, and might I add pretty painful, hit to stock prices of insurance carriers like Cigna, Aetna and UnitedHealth, there won’t be any immediate repercussions.

What can be speculated though is that these three enormous companies will make potentially huge waves as they pull employees off current major carriers’ services. Depleting members reduces the pool of money that insurance carriers will have for their own claims and administration. If the majority of those leaving are young, healthy people, some Americans could see an increase in costs for their insurance plan — on top of already rising prices in the industry overall.

On a more positive note, new enthusiasm and innovation might just be what the industry needs. Having new blood in an incredibly old, often entrenched system might spur creative strategies to encourage savings. Major carriers across the country will have to do something to shore up for the changes this new company could bring.

Ultimately employees of the three companies will benefit first as the new healthcare company will be staged to take care of just them as a starting point. If Bezos statement rings true after this initial step, it may benefit “potentially, all Americans” by providing healthy competition into an ever-shrinking market.

Changes to Our Phone Operating System

by ClaimLinxJanuary 19, 2018December 4, 2019Leave a comment

Last week ClaimLinx conducted a trial of a change to our customer service phone operator from a local attendant to an auto attendant. We believe this transition will ensure members and administrators will reach their desired departments faster, and with less front-end explanation.

This change will remain permanent for the foreseeable future. We have already seen an improvement in our call efficiency. We have found members are able to reach the claims department quickly, without having to explain their issue to multiple people.

Below are the options all callers hear when reaching the general ClaimLinx customer service numbers, (800) 858-1772 or (513) 677-6262.

Dial 1 – If you are a member or provider’s office calling about claim status, benefits or eligibility
Dial 2 – If you are an administrator or broker
Dial 3 – If you are in need of insurance
Dial 4 – Lisa Grubb, ClaimLinx Health Insurance agent
Dial 5 – Kathy Durnell, ClaimLinx Health Insurance agent
Dial 6 – To reach accounts receivable
Dial 7 – General mailbox

Administrators and members can still reach specific ClaimLinx team members by dialing their extensions or their direct lines.

ClaimLinx Solves Spiking Insurance Premium Problem

by Whitney FaberDecember 13, 2017December 4, 2019Leave a comment

Cincinnati business finds ways to save on employer-sponsored health plans

CINCINNATI, Dec. 13, 2017 /PRNewswire/ — Right now at small businesses all over the country, administrators are making a grim choice – cut benefits for next year’s insurance plan or face strained resources to cover their premium increase.

Premiums for employer-sponsored health benefits for 2018 are expected to be the highest since 2011, according to the human resources consultancy Mercer’s 2017 National Survey of Employer-Sponsored Health Plans.

Blame it on Washington, D.C., blame it on insurance company stakeholders, blame it on anyone who unjustly seems to pull in profits through the industry. It all adds up to one thing: employers and their employees are continuously being asked to pay more to receive less.

But for one company in Cincinnati, this is a problem with a simple solution. ClaimLinx, a full-service consultant, insurance agency and third party administrator, has pioneered new ways of purchasing health insurance so companies can cut costs without sacrificing benefits, such as increasing deductibles or copays.

“Our whole goal is just to save people money on their health insurance – it’s hard sometimes but when we do it’s incredible what it can do for a business,” said Christy Quigley, President of ClaimLinx.

They do this by combining a high deductible insurance plan through a major carrier — Anthem, Humana, Aetna, Cigna — with a self-funded medical expense reimbursement plan.

The trick is to take the best of both types of insurance.

From the plan through a major carrier the company receives resources, including a wide physicians network, competitive discounts on procedures and a stop loss in case any employee has high medical costs.

Related Post: What is a Section 105 Plan?

From the medical expense reimbursement plan the company has the ability to customize its own copays and deductible while still receiving the tax benefits exclusive to a self-funded plan through section 105(b) of the IRS code.

Tom Quigley, National Business Consultant at ClaimLinx, said he sees business owners struggling with decisions about their plan every day when they don’t need to.

“What it really boils down to is a math problem. The problem is it can be hard to take the emotion out but you really have to when it comes to your benefits.”

For more information go to www.claimlinx.com or inquire directly to Whitney Faber at wfaber@claimlinx.com or (617) 892-4655.

View the published press release.

Tips for Helping Members With Claims Issues

by ClaimLinxDecember 8, 2017December 4, 20191 Comment

Administrators for the Medical Expense Reimbursement Plan (MERP) sometimes have members reach out with problems or questions regarding their claims.

Here are some tips to give employees if they have questions or issues with the claims process:

Be proactive – Remind members to check their primary insurance network and any required preauthorization before a procedure or appointment. Changes to networks or primary insurance carrier’s policies can be made at any time during the year.
Check during processing – A claim goes through many steps before a provider or facility receives payment – see the attached step-by-step diagram – and it’s important to follow all claims throughout this process. Members can check claim status at any time using the ClaimLinx member portal by going to http://www.ClaimLinx.com and clicking the green “Member Login” button.
Communicate with provider billing – Some provider billing departments have short timelines as to when they begin pursuing patients for payment. If a member is receiving calls from a provider billing department and is waiting for a claim to be processed, he or she can explain this to the office to be noted on the claim.
Be patient – The process can sometimes take time, which can be frustrating. But it’s important for members to remember there are many resources to help, including the the claims department at your primary insurance carrier and at ClaimLinx. Members may contact the claims department at any time by emailing help@claimlinx.com.