Monthly Archive for August, 2009

GuideSpark Announces New Hire Training and Open Enrollment Modules

Published by JLarocque on August 31, 2009 in Benefits, Financial Wellness, Solutions and for Employers. 0 Comments Tags: , , , .

Today, GuideSpark announced two new modules for its Benefits Learning Center solution.  These modules automate and streamline New Hire Training and benefits communications for Open Enrollment.  As companies continue to prioritize doing more with less, many employers are looking for more efficient and effective ways to deal with these resource-intensive processes.

Consider for a moment the staff time and dollars go into facilitating New Hire Training and Open Enrollment each year.  Many companies we’ve met with offer half-day New Hire orientations on a near weekly basis.  Not to mention the time and effort that goes into the creation of the stacks of paper that employees receive on their first day.  Open enrollment presents a similar situation.  Each year, HR staff offer a collection of live seminars to explain benefits changes, often preceded by brochures, mailers and the like.  Despite all of this effort, nearly 80% of employers believe that their employees do not have a good understanding of their benefits.

Many employers have asked us how they free up their valuable, and in many cases shrinking HR staff to work on strategic projects while improving rates of benefits understanding among employees.  In addition, finding ways to communicate effectively has become an even higher priority as employers prepare to make difficult announcements about cutting programs and/or asking employees to take on a greater share of health care costs.

Our answers to such questions naturally start with what we know to be true about today’s employees:

  • First, given the trend of increasingly distributed workforces and the importance of family decision makers, on-site seminars fail to provide reach
  • Next, given the explosion of web multimedia and sites like YouTube, employees have become accustomed to rich, short-form content.  The busy professional of today simply does not have the attention span to thumb through lengthy benefits documents.

GuideSpark’s Benefits Learning Center modules embrace these trends to provide a modern and engaging multimedia solution capable of reaching your distributed workforce and their families.  This online solution automates open enrollment and new hire training workflows to free up valuable resources.  Employees have on demand access to a library of multimedia benefits presentations, allowing them to direct and personalize their learning experience.  In addition, these modules offer custom checklists for open enrollment and new hire on boarding, so that employees can conveniently track their progress.

Please take a look at the New Hire Training and Open Enrollment demonstrations on our site to better understand the power of these new modules.

BEWARE: Usual, Customary and Reasonable Charges

Published by JLarocque on August 19, 2009 in Benefits. 1 Comment Tags: , .

I visited my childhood pediatrician until age 28.  Why?  Well, I trusted his judgment and there was just a huge amount of peace of mind that came with dealing with a physician who had first-hand experience with just about every entry in my medical history.  Dr. Blair was never once in the network of doctors offered by my medical plans and therefore I had to pay 20% more for care.  Fortunately for me, it was only 20%.

What you may not know is that each year Americans incur significant unexpected charges when they pursue out-of-network care.  The issue is that your insurer will pay only a percentage of what they deem to be “usual, customary and reasonable” for the services provided.  So, while the insurer will provide 70% coverage of the medical test you had done as promised, it may only be 70% of the “usual, customary and reasonable” or UCR amount of $300 vs. 70% of the $500 your physician has charged for the test.  And yes, that’s right, you are stuck with the difference.  You can imagine how, in the case of major procedures, you may be responsible for thousands of dollars in unexpected medical bills for utilizing that highly recommended surgeon who happens to be out-of-network.

So, if you’re utilizing out-of-network care, experts recommend you take the following steps for ensuring that you aren’t surprised by UCR charges and optimize your plan benefits:

  1. Talk to your doctor and get the charges and procedure codes for your insurer
  2. Provide the codes to the insurer and understand how much they will pay
  3. Negotiate with your doctor, particularly if his/her cost for the procedure is more than the UCR amount.  It is often effective to agree to pay your portion of the services up-front so that they can avoid lengthy waiting periods from your insurance company.
  4. Utilize flexible spending accounts.  Many times the types of procedures or tests that involve large out-of-pocket expenses can be foreseen and planned for.  If this is true in your case, be sure to take advantage of FSA programs that allow you to pay your portion with pre-tax dollars.
  5. If you’re a member of a high deductible health care plan, be sure to tap into your employer provided health savings account or health reimbursement arrangement to pay down the amount that may be due.

This is a great plan in theory but unfortunately you may be challenged to complete steps 1 and 2. While codes and costs are critical to understand up front, they are very hard to get.  The reason is, insurers consider their negotiated rates to be proprietary.  They negotiate with each doctor and facility individually to minimize their costs and therefore it is to their advantage to maintain confidentiality.  However, that does not mean that you should not ask for this information and continue to ask for it until you get it.

The good news is that there is pending legislation for more transparency when it comes to costs.  Earlier this year, UnitedHealth agreed to pay hundreds of millions of dollars to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network.  Some health care insurers such as Aetna and CIGNA have taken the lead on transparency, publishing the negotiated rates of tens of thousands of physicians in their network.  And with high deductible health care plans becoming more popular, the need for transparency is becoming ever more critical.

For years, patients have avoided asking about the cost of services, physicians don’t volunteer it and members find out what their ultimately responsible for after the fact.  Don’t be surprised by health care costs, be proactive.

I visited my childhood pediatrician until age 28.  Why?  Well, I trusted his judgment and there was just a huge amount of peace of mind that came with dealing with a physician who had first-hand experience with just about every entry in my medical history.  Dr. Blair was never once in the network of doctors offered by my medical plans and therefore I had to pay 20% more for care.  Fortunately for me, it was only 20%.

What you may not know is that each year Americans incur significant unexpected charges when they pursue out-of-network care.  The issue is that your insurer will pay only a percentage of what they deem to be “usual, customary and reasonable” for the services provided.  So, while the insurer will provide 70% coverage of the medical test you had done as promised, it may only be 70% of the “usual, customary and reasonable” or UCR amount of $300 vs. 70% of the $500 your physician has charged for the test.  And yes, that’s right, you are stuck with the difference.  You can imagine how, in the case of major procedures, you may be responsible for thousands of dollars in unexpected medical bills for utilizing that highly recommended surgeon who happens to be out-of-network.

So, if you’re utilizing out-of-network care, experts recommend you take the following steps for ensuring that you aren’t surprised by UCR charges and optimize your plan benefits:

1. Talk to your doctor and get the charges and procedure codes for your insurer

2. Provide the codes to the insurer and understand how much they will pay

3. Negotiate with your doctor, particularly if his/her cost for the procedure is more than the UCR amount.  It is often effective to agree to pay your portion of the services up-front so that they can avoid lengthy waiting periods from your insurance company.

4. Utilize flexible spending accounts.  Many times the types of procedures or tests that involve large out-of-pocket expenses can be foreseen and planned for.  If this is true in your case, be sure to take advantage of FSA programs that allow you to pay your portion with pre-tax dollars.

5. If you’re a member of a high deductible health care plan, be sure to tap into your employer provided health savings account or health reimbursement arrangement to pay down the amount that may be due.

This is a great plan in theory but unfortunately you may be challenged to complete steps 1 and 2. While codes and costs are critical to understand up front, they are very hard to get.  The reason is, insurers consider their negotiated rates to be proprietary.  They negotiate with each doctor and facility individually to minimize their costs and therefore it is to their advantage to maintain confidentiality.  However, that does not mean that you should not ask for this information and continue to ask for it until you get it.

The good news is that there is pending legislation for more transparency when it comes to costs.  Earlier this year, UnitedHealth agreed to pay hundreds of millions of dollars to settle class-action lawsuits brought by the American Medical Association and other groups on behalf of patients and doctors who claimed to be shortchanged for services provided out of network.  Some health care insurers such as Aetna and CIGNA have taken the lead on transparency, publishing the negotiated rates of tens of thousands of physicians in their network.  And with high deductible health care plans becoming more popular, the need for transparency is becoming ever more critical.

For years, patients have avoided asking about the cost of services, physicians don’t volunteer it and members find out what their ultimately responsible for after the fact.  Don’t be surprised by health care costs, be proactive.

The $4.5 Billion Productivity Drain – Employee Financial Distress

Published by KKitani on August 10, 2009 in Financial Wellness and for Employers. 0 Comments Tags: , .

A recent BusinessWeek article “Helping an Employee in a Personal Financial Crisis” had a number of eye-opening estimates about the effect of financial distress on employees and employers.  The article sites the Personal Finance Employee Education Foundation estimating the cost of personal financial woes to corporations at $4.5 Billion annually and a Chicago consultant estimating a financially unstable worker can cost a company as much as $480 per month.

As a company focused on improving the financial health of employees, it’s good to see BusinessWeek covering small business examples, as it shows the depth of the problem.  While larger companies like IBM, Pepsi and Home Depot have received good press coverage over the past few years for their financial education and literacy programs, smaller companies are also taking notice and implementing programs.  I think this section from the BusinessWeek article sums it up the problem well:

As the recession grinds on, more companies find themselves managing workers facing personal financial crisis. And while employers like Humanix treat workers like family, taking care of them makes business sense as well. “I don’t want to make it Pollyanna,” says Humanix’s Nelson. “If an employee has a stressful financial situation at home, they’re not going to be fully engaged in their job.”