A case study of an employee who needed an advocate while dealing with medical bills resulting from the employees child’s emergency treatment. The child of a client’s employee suffered a fall and broke five teeth while away at college. The student needed two root canals, an ambulance ride to the hospital, an emergency room visit, a CT scan, and restorative dental work. After multiple bills from different medical and dental providers began to accumulate, the employee contacted the insurance companies to find out which services were covered but got inaccurate information. The Paradigm Group claims advocacy team worked directly with the employee to explain the various bills and ensure that claim were filed correctly. In addition, the team convinced the student’s out-of-network dentist to accept the insurance company’s in-network fees as payment in full and to file claims with the medical plan rather than with the dental plan.
A case study of a 670 employee community bank that wanted help assessing the value of its self-funded medical plan. Community bank sponsored a self-funded medical plan administered by a local third party administrator (TPA). This was in response to high medical claims, benefits that were not competitive with other local employers, and unfunded medical cost reserves. Paradigm Group analyzed claims data and compared multiple carrier and TPA pricing proposals to determine whether the bank had the best available provider network and the most favorable network discounts. The process identified a carrier whose provider network was not only much larger but also had better discounts than the incumbent’s. Paradigm Group moved the bank’s self-funded medical plan to the new carrier/administrator.
A case study of a 1206 employee auto insurance carrier that wanted help reviewing its renewal rate. An auto insurance company’s medical carrier proposed a 10% rate increase at renewal. Paradigm Group’s underwriting team reviewed the client’s claims and determined that the data indicated that no rate increase was warranted. The underwriting and account management teams worked with multiple insurance carriers to obtain competitive quotes for comparable benefits. By using this marketplace data and challenging the carriers’ underwriting methodology, the team successfully negotiated a lower renewal rate with a new carrier.
A case study of a 733 employee construction trade company that wanted to save money on its medical plan while maintaining the same level of company benefits. Construction Trades wanted to implement an innovative medical plan that would save money without reducing benefits. Success of this new arrangement hinged on employees’ novel usage of their benefits at point of service. Paradigm Group’s account management team knew that employees had historically accessed their various benefits in the same way, but that the new medical plan would require a different process. They recognized that although the employer’s plan was comprehensive and competitive, employees’ attention likely would focus on the new process, which could be confusing without careful explanation. The team decided to avoid complicated verbal and written communications in favor of simple graphics designed to give employees easily understood and readily recalled images to use when they used their medical plan benefits. The images were featured in an initial announcement and reinforced in the open enrollment presentation and meeting handouts.