Research

THE LAW OF DISPROPORTIONATE COSTS: SMALL NUMBER OF EMPLOYEES ACCOUNT FOR LION’S SHARE OF GROUP HEALTH PLAN MEDICAL COSTS

There’s plenty of cost related analytics available to support the disproportionate cost premise that medical expenses are highly concentrated among a very small proportion of enrolled employees.  These highlights, for example, from a Agency for Healthcare Research and Policy (AHRQ) are pretty telling:

  • 1 % of the population accounts for 21.4 % of total health care expenditures nationally
  • 5 % of the population account for 49.9 % of total expenditures
  • 10 % of accounts for 65.6 % of all medical costs

Costs For Routine Colonoscopies and Who Pays? It Can Be A Real Pain… In the Pocketbook.

We’ve seen quite a spike recently in the number of claims issues clients’ employees are reporting related to the coverage of colonoscopies.  The problem almost always centers on billing for the service and payment of the claim.  Many employees report that they are being forced to pay out-of-pocket for colonoscopies that they believe should be fully covered under preventive care benefits.

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