Providing employees with high quality healthcare for severe health conditions like arthritis or certain diseases can be hard on companies’ bottom lines and employees’ bank accounts. And frequent visits to doctor’s offices or hospitals can be exhausting and take a toll on a patient’s mental well-being.
One of EVHC’s customers experienced these challenges firsthand. An employee was receiving regular treatments of Remicade, a drug that treats arthritis and other ailments. Every six weeks, the employee had to travel 40+ miles round trip to and from the hospital and spend six hours receiving the infusions. Each treatment cost the employees’ company a staggering $27,000.
Before turning to EVHC, the company and employee just accepted this situation—but it didn’t have to be this way. The expensive, time consuming, and exhausting process was the result of auto adjudication from the employer’s fully funded carrier. Auto-adjudication is when an insurance company pays or denies an insurance claim automatically, without actually looking closely at the claim. Injectable drugs like Remicade are often auto adjudicated by carriers, who don’t bother to try and help employers and plan members save headaches and money.
This employer and plan member had enough. So, they contacted EVHC.
Unlike traditional fully insured carriers, which typically auto-adjudicate 90% of claims, we limit our auto adjudication to 65% of claims. Instead of automatically passing along higher costs, we pour over complex cases to help clients—like the one depending on Remicade—save time, money, and their sanity.
Our process doesn’t just help employers save money in the short-term—it also helps them avoid paying higher premiums when it comes time to renew. Not auto-adjudicating every claim keeps companies from having to exceed their specific insurance coverage and resort to stop-loss. When an employer goes into stop-loss, fully insured carriers will pay the overage—but to make up that money, they’ll jack up next year’s premiums. This costs companies and their employees a lot of money that could have been saved if their carriers had been willing to work with them in the first place.
Fortunately, our customer found EVHC. We were not only willing to work with them, we were also willing go the extra mile to save them and their employee a lot of money, time, and energy.
Immediately, our representatives went to work to find an alternative to the frequent trips to the hospital. The answer was simple: home healthcare treatments. We worked with the employer and the employee and their physician to get a home health regimen approved, planned, and implemented. The physician also wrote a prescription for Remicade that the employer could pick up at a local pharmacy—a far better option than driving 40 miles.
Both the employer and employee benefitted from this plan:
Healthcare shouldn’t mean jumping through hoops, waiting on hold Waiting on Hold Instead of Getting Care An investment research company based in New York, needed an insurance company that would work with them—not against them. More specifically, the owner’s wife found herself constantly dealing with the burden of multiple phone transfers, being put on hold, and fighting to fill prescriptions and gather essentials for their diabetic son. With over 200 employees, it became clear that if the owners were seeing this amount of hassle just to maintain their basic healthcare needs, then their employees must be struggling as well. They needed a healthcare provider that would: - Eliminate the need for constant calls and follow-ups, freeing up personal time - Make employees feel heard, appreciated and respected - Maximize the cost-to-coverage balance, without dramatically upping prices - Find lasting solutions with flexible options “I can’t be the only one who is filled with dread when I hear hold music! Watching family members deal with health issues is stressful enough without having to jump through hoops to merely fill a prescription. It felt like my wife was constantly fighting with our insurance company, instead of them being on our team.” Partially Self-Funded Insurance, With a Personal Touch This financial investment company found their home with EVHC and our customized partially self-funded insurance plans. A key aspect of that customization is the fact that EVHC provides a one-on- one personal concierge-level service meant to make employees feel supported. EVHC provided: -24/7 concierge-level customer service, including member education programs -A personal EVHC account manager, who works tirelessly to ensure every item that employees, their families, and kids need is covered -Direct member engagement, where people’s needs and concerns are not just heard, but addressed -The ability to consolidate basic services into a mail order prescription offering, so essential supplies are received on a quarterly basis -Flexible plan designs, including home healthcare and diabetes treatment options “The whole point of health insurance is to make employees feel protected and support. Insurance shouldn’t feel transactional or complicated. For the first time, our employees and families are getting the support they need—around the clock—instead of having to fight for it.” Peace of Mind and Saved Time In just the first year, this company experienced: -All their healthcare needs and services fulfilled without having to continuously call or wait on hold to ensure basic needs were met -Fewer headaches dealing with health insurance, more time to devote to the business -The peace of mind that comes with personalized service and support Partially self-funded insurance is already a paradigm shift, but EVHC is taking it to the next level by offering personalized coverage and support. For far too many, dealing with insurance providers has required speaking to a computer, constantly being put on hold, and having to jump through hoops for the most basic of care. Time that should be spent with loved ones and furthering business needs is instead spent stuck in frustrating customer service cycles.READ MORE
Partially self-funded insurance reduces costs by 28% with no coverage loss Save without Sacrifice Each year, health insurance premiums go up, forcing employers to shop around and, usually, ending up right back at square one. Whatever they do, companies end up paying more than they should because the alternative—reducing benefits or limiting network access—is simply not an option. Tired of the costs and headaches associated with fully insured options, one company began to explore the benefits of partially self-funded insurance and how it could help them: -Keep their margins (the difference between claims liability and actuarially expected claims) -Cut pharmacy spending -Retain access to the nation’s largest provider networks “We needed a solution that allowed us to save money while still providing our employees with access to the best provider networks. We weren’t getting that through traditional fully-funded insurance.” EVHC’s Partially Self-funded Insurance The company turned to EVHC, which offers custom plan designs that help companies save money without losing coverage. Through EVHC, the company had: -Access to three of the nation’s four largest provider networks -24/7 concierge-level customer service, including member education programs -Flexible plan designs -Greater price transparency “EVHC was easy to work with and a true partner. They were there every step of the way, from implementation to enrollment and beyond.” Thousands Saved, No Coverage Lost In just one year, the company experienced:READ MORE
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