Jun 26, 2025

When a $1.5 Million Hospital Bill Gets Reduced to $290,000, Payment Integrity Is Why

A lung transplant billed at $1.5 million. An organ charged at $676,000 when the legal maximum is $56,000. After a payment integrity review removed the ineligible charges, that bill came down to $290,000. That's not an edge case — for...

Jun 19, 2025

Per-employee rebates paid to employers have increased almost threefold since 2017. Over that same period, total drug costs still rose by nearly 24%. So what exactly are those rebates buying? That's the uncomfortable question at the center of this Summer Short.

In this Summer Short Stacey Richter speaks again with...

Jun 12, 2025

Stop-Loss Reinsurance Pitfalls: What Self-Insured Plan Sponsors Need to Know

Stop-loss carriers shoot for 30 to 40% margins on the policies they sell. That figure came from the CEO of a large stop-loss carrier, in what Andreas Mang describes as a moment of weakness. If you're a self-insured employer and you haven't been...

Jun 5, 2025

Five Hidden Fees in Your Claims Wire That May Be Costing Your Plan Millions

The weekly claims wire looks like a payment for medical and pharmacy claims. But tucked inside that same wire, invisible to most plan sponsors, are fees that have nothing to do with the care your members received. One multi-employer fund reduced...