An update on why Medical Loss Ratios are important
- Wednesday, 15 June 2011 19:09
The Health Care Reform act includes the limitation of how much a plan must pay out in claims. The unintended impact of this is the reduction in service (already) by most broker. For insurers, cutting commissions was the easiest way to meet the requirements. More than half of brokers have seen cuts of 25% and some have seen cuts of 50%. To put this into perspective, a typical small group with 5 employees, pays about $3600 a month in premiums, of which $144 is commissions to the agent (some is also kept by some carriers or general agents). On average, I found that a 5 person group average 15 issues a year, averaging about 20 minutes per call to discuss, resolve, and report back. Thats 5 hours. Negotiating the renewal, setting up the paperwork, drafting the employee memos, holding the educational meetings, handling the phone calls and getting everything processed takes about another 5 hours.
Calculating in staff salaries, copy cost, technology and other overhead (phones, rent, etc) that leaves about $250 profit before taxes.
Now lets cut that by 25-50% and any small business owner can see the problem. The broker is left no choice but to cut back somewhere. A recent study shows that 13% have laid off staff, 30% have cut services already, and another 30% plan to by year end. Nearly 40% have stopped selling policies for individuals (they pay less)
Brokers do much more than sell insurance – They serve their clients (not the insurance companies), helping peol;le when they have trouble getting procedures done, guiding them through the system, handling questions and concerns. The provide clients with advice and guidance on the ridiculous amount of regulations that impact every decsion that an employer makes. They provide individual enrollment guidance for each and every employee.
Just thought you should know.
Provider Changes at Carolina Care – Important
- Wednesday, 15 June 2011 13:01
Pitts Radiology Associates Rejoins Network
Medical Mutual and its Family of Companies have reached an agreement with Pitts Radiology Associates— a radiology services provider at several hospitals in South Carolina, including Kershaw County Medical Center, Newberry County Memorial Hospital, Palmetto Health and Providence—to provide in-network services to our members.
The Company had previously been unable to come to an agreement with this radiology provider, which went non-contracting beginning September 30, 2009. Services received on or after May 15, 2010, were charged at non-contracted rates.
Claims for services received on or after June 1, 2011, will be paid according to the terms of the new agreement.
If you shared information about the network termination with your clients, please update them on the positive outcome of this situation.
Columbia Skin Clinic Goes Non-Contracting
CCP’ agreement with Columbia Skin Clinic will terminate effective July 15, 2011. This dermatology group includes 11 providers that provide services in Kershaw, Lexington and Richland counties in South Carolina.
Services received from Columbia Skin Clinic on or after July 15, 2011, will be considered out-of-network. Please encourage your groups to remind their employees to use in-network facilities whenever possible to receive the highest level of benefits and avoid higher out-of-pocket costs. A complete list of network providers is available on CarolinaCarePlan.com using the Provider Search tool.
Members who have received services from Columbia Skin Clinic in the past 12 months will receive a letter notifying them of this change. Group officials with affected employees will also receive a notification.