Healthcare Services

Pharmacy Benefit Management – Part 3 – Case Study

How can your company reduce pharmacy costs while providing the best care and service to employees?  Our PBM model consistently delivers high value and significant savings to clients. While each element of our program produces savings for clients, the savings are maximized when all programs are implemented. As each pathway targets different savings opportunities. In nine months, our client achieved $54K in savings through clinical management of the various pathways. The analysis was conducted for our  client that has 86 lives and a total of 105 members.

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Pharmacy Benefit Management – Part 2

Do you know how specialty medications are impacting your company’s health insurance costs? While specialty medications offer promising treatment options for complex conditions, their high cost can pose challenges for affordability and access, impacting both patients and healthcare systems.  Specialties not only cause significant increases to the overall plan, but can impose financial hardships on employees.

 

 

 

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Pharmacy Benefit Management – Part 1

When medication costs go up, insurance costs follow suit because insurance companies have to cover those expenses. So, rising pharmaceutical medication prices can lead to higher health insurance premiums for consumers. If you are self-funded and using a Pharmacy Benefit Manager you need to understand how your PBM is managing the cost of pharmaceuticals.

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Many Patients Billed for Preventive Care That Should Be Free

People are being charged for preventive health care, health care that should be at no cost to them. That’s the headline from an article in the US News & World Report by Robert Preidt, HealthDay Reporter.

The article stated, “Out-of-pocket charges for preventive care that should be free under the Affordable Care Act can discourage patients from receiving recommended care…”. While a majority of patients are receiving preventive care for free, those who were charged only paid about $20 or less.

Unexpected charges were also common for routine screenings for cancer, diabetes, cholesterol, depression, obesity, and sexually transmitted infections, as well as pregnancy-related services.

The primary conclusion of the study was these charges were discouraging future health care screenings.

 

Employee Benefit Advisors provides, employee benefits, Healthcare Consumption Audits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

No More Surprises

Shock by your hospital bill?The No Surprises Act, a ban on surprise medical bills, will take effect beginning in 2022.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. – A patient goes to an in-network hospital for surgery or emergency care, and an out-of-network doctor is involved in the patient’s care. Patients are not able to determine the network status of providers, such as emergency room doctors or anesthesiologists. The patient is simply not involved in the choice of provider.

No Surprises Act

The Act applies to surprise bills from doctors, hospitals, and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances. Providers will have to work with the health insurance issuer carrier to determine the appropriate amount to be paid by the plan.

(The No Surprise Act was included in the stimulus bill signed by President Trump on Dec 27, 2020.)

EBA will continue to keep you updated as information becomes available on the details of the law.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Let the dogs out!

Surprise medical bill? – Surprise medical billing applies to fully-insured commercial insurance plans.   No federal laws exist to prevent surprise medical bills and of the states that do less than half provide comprehensive legislation.   Employees are confused when they receive a surprise medical bill and it generally reflects poorly on the company plan when it occurs.

Bill Dog was made for the moment a confusing medical bill arrives. Members can be confident before paying any medical bill. Bill Dog researches and explains every situation to our members.

  • What is the bill for?
  • What are the codes?
  • Are the charges too high?
  • I have insurance, why do I have this bill?
  • I am confused.

Bill Dog works directly with members, providers, and insurance companies to resolve issues, support appeals, and assist with price negotiations. Bill Dog provides an easy way to verify any medical bill so it can be negotiated and paid with confidence. It is easy to use. You can reach them by phone, chat, email or direct message. Codes and charges are verified. Billing errors are identified and corrected. Appeals and price negotiations are supported. It is results driven. Errors are identified and corrected — claims denials and out of network charges are verified.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

OSHA Recommends that Employers Encourage Workers to Wear Face Coverings at Work

As businesses open and employees return to work, large numbers of employees of workers will be required to wear faces masks in the workplace.

The Occupational Safety and Health Administration (OSHA) has published a series of answers to frequently asked questions (FAQs) regarding the use of masks in the workplace to help employers provide a safer work environment. The guidance outlines the differences between cloth face coverings, surgical masks and respirators.

Guidance includes:

  • Cloth face coverings are not considered personal protective equipment and employers are not required to provide them. (Employee Benefit Advisors believes this is an extremely important as it could provide the employer a layer of liability protection.)
  • OSHA generally recommends that employers encourage workers to wear face coverings at work.
  • Cloth face coverings are not a substitute for social distancing measures.
  • OSHA suggests following CDC recommendations, and always washing or discarding cloth face coverings that are visibly soiled; and
  • Employers must not use surgical masks or cloth face coverings when respirators are needed.

Click here for more information.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Florida’s COVID-19 Data and Surveillance Dashboard

The link below provides some very insightful data regarding the spread of COVID-19.

https://experience.arcgis.com/experience/96dd742462124fa0b38ddedb9b25e429

The chart in the lower left is particularly interesting. Obviously, one would expect an increase in cases as the number of tests increase. However, note the trend of the decrease in the number of new cases.

What does this mean? To me it says we may be getting ready, hopefully, to start the economy back up. It also suggests we should start thinking about how to restart our businesses. – Need help planning the restart? I know people, experts – people that can help. – Let me know what you need, I’ll help you find the right person.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

COVID-19 and Medicare

Employee Benefit Advisors recommends communicating the following to you employees. Odds are your company has either employees on Medicare, family members on Medicare, or both.

Copays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

Telehealth – CMS announced that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement. Email and texts to docs will be possible! Read the CMS details here

Cost of testing – Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). https://www.medicare.gov/coverage/coronavirus-test

3 Day Hospitalization Waived for Skilled Nursing Facilities – The waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities). Click here to download the full CMS memo.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Coronavirus – easy to understand info for employees

Symptoms people may experience:
1. runny nose (Not to be confused with allergies)
2. sore throat
3. cough (develop the habit of coughing into your sleeve or handkerchief – never your hand!)
4. fever
5. tightening of chest / difficulty breathing (severe cases)

What can you do?
• Emergency Room – very expensive
• Urgent Care – less expensive than ER but more cost-effective options exist
• Primary Care Physician – generally a low flat copy; at most the contracted rate between the physician and insurance company
Because COVID-19 is highly contagious to prevent contaminating health care service workers, it is not recommended you go directly to the              ER, UC or PCP.
Telemedicine – no cost! – If you need emergency care or any additional care the doctor will advise you.
(According to the Centers for Medicare & Medicaid Services (CMS), Essential Health Benefits (EHB) coverage generally includes coverage for the diagnosis and treatment of COVID-19.)

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Back to top

Submit your Feedback

      Sending...
x