KALEIDOSCOPE Podcast EP 10: Reducing Waste, Abuse, & Fraud in Healthcare Plans

KALEIDOSCOPE brings you unique new perspectives on the world of insurance through discussions with industry leaders, influencers, and idealists.

In this episode of Kaleidoscope, we discuss how employers can reduce the waste, abuse, and fraud often found in health care plans. Through the help of experts and technology, we outline a process to identify these unnecessary costs in a sensitive and quantifiable way.

Joining us is Will Baker, National Sales Director at BMI Audit Services. Will has over 20 years of experience helping employers and their advisors with health care costs containment by identifying ineligible plan participants and claims overpayments.

Key Takeaways:

  • Claims are becoming more complex and payment systems have become more sophisticated. Payment errors continue to happen.
  • There is a lack of transparency with customer service. There are more and more TPAs prohibiting employers from looking at the details behind claims data. Audits today are taking 5-7 months to complete, almost twice as long as just a few years ago.
  • Brokers need to do their due diligence during client renewals and while moving to a new TPA. To identify and prevent any restrictions around audit rights, it is recommended to go through all ASO contracts.
  • There is a growing trend of brokers who understand the value of having an independent 3rd party audit plan set up. This ensures a client is set up for success and accurate benefits are being provided to plan members.

This episode is hosted by Frank Pennachio and Susan Toussaint of ReSource Pro’s Growth Solutions Practice. We provide insurance agencies and carriers with consulting and training services, enabling them to elevate sales conversations, compete more effectively in the marketplace, and grow organically. To learn more, visit the Growth Solutions website, or reach out to Susan Toussaint.

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