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:
0 rate increases, great coverage, and millions of dollars saved result in a win for car dealership and its employees Drive Costs Down, Maintain Great Coverage Tired of the skyrocketing costs and headaches associated with their fully insured carrier, one of the Southeast’s largest car dealerships began to explore the benefits of partially self-funded insurance. This Georgia-based automotive company has 28 dealerships and more than 700 employees. They were paying a fully insured carrier millions of dollars per year—and the carrier planned to increase those annual costs by 38%. They were also struggling to manage plans across dealerships, all of which had their own unique coverage. This automotive company looked at partially self-funded insurance alternatives to help them: - Keep their margins (the difference between claims liability and actuarially expected claims), resulting in millions in savings - Consolidate insurance coverage across all dealerships - Retain access to the nation’s largest provider networks - Provide employees with even better coverage options “When the carrier told us about their proposed rate increase, I was shocked. How were we supposed to be able to pay those margins? We desperately needed an alternative that would provide our employees with great care without breaking the bank.” EVHC’s Partially Self-funded Insurance This automotive company turned to EVHC, which offers customized partially self-funded insurance plans that help companies save money without losing coverage. EVHC provided them with: -The ability to only pay for the actual cost of employees’ claims -Low individual deductibles -Access to three of the nation’s four largest provider networks -24/7 concierge-level customer service, including member education programs -Flexible plan designs, including home healthcare and diabetes treatment options -Greater price transparency For the first time ever our premiums remained flat year-over-year. That, combined with millions in overall savings, great customer care, and even better benefits for our employees, has made our relationship with EVHC a winner. Millions in Savings, Better Coverage In just the first year, this automotive company experienced: - A consolidated insurance plan covering 700+ employees across 28 dealerships for easier administration and better continuity - $1.4 Million in Savings - 100% of employees covered at no risk to the company EVHC is also creating a customized diabetes management program with partner Livongo that will allow diabetic employees to enjoy cost savings, direct delivery of supplies, and more, and helping this automotive company save money on internationally-sourced prescription drugs.
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Company Gains a Competitive Advantage Through Partially Self-funded Insurance Break down health insurance barriers A New York-based financial services firm that employs some of the world’s brightest young minds from the worlds of mathematics, computer science, statistics, physics, and more was looking to enhance employee productivity through better healthcare. The company competes with major corporations to recruit employees from some of the country’s top schools and has built an exemplary corporate culture onsite restaurants, gyms, and other amenities) that encourages productivity. The firm found that traditional fully funded healthcare plans didn’t fit with this culture. It needed solutions that were flexible, easy to use, and didn’t get in the way of employee productivity. Company management wanted their employees to focus on work, not overcoming the barriers (dealing with hard to work with carriers, navigating complicated networks and coverage plans, and more) typically associated with health insurance. The firm looked at partially self-funded insurance alternatives to help them: - Attract top-tier talent through health insurance benefits - Eliminate the number of hours employees waste talking to insurance carriers so they could focus on their jobs - Provide employees with great coverage options EVHC’s flexible partially self-funded plans The firm turned to EVHC, which offers highly customized and flexible partially self-funded insurance plans that allow employees to enjoy unparalleled coverage while providing companies with exceptional insurance benefits. EVHC provided the organization with: - A customizable plan that allows employees to use both in-network and out-of-network providers at little cost - Access to three of the nation’s four largest provider networks - 24/7 concierge-level customer service, including member education programs - Low individual deductibles - Greater price transparency - An easy-to-use HRIS platform for fast access to health insurance information, improving productivity and time savings - Insights into employee wellness across four categories (colorectal cancer screening, cervical cancer screening, flu vaccination, and breast cancer screening) Happier employees—and a competitive advantage The firm is now able to offer new and current employees with no hassle health insurance coverage that fits their culture and employees’ lifestyles. Many of the company’s employees are young, fresh out of college, and working hard at jobs they love. They don’t have time to worry about the hoops a fully funded provider will put them through. Now, they don’t have to. They can focus on being productive, driving business for the company, staying healthy, and enjoying the complimentary video games (and the firm’s many other great perks).
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