While we all start to sit down, our broker tries to put us at ease by cracking a few jokes. No matter how funny the humor, it doesn’t overshadow reinsurance renewal time for our self-insured plan.
The process starts with an overview of how many self-insured claimants hit specific level, came close, or how near we were to our aggregate attachment point.
We also review any significant diagnosed conditions that might exist and also examine the total amount of premium spent versus reimbursement. We review the numbers and a blues ballad starts blowing in the wind.
It’s the same old deal, the same old sad song. “Your catastrophic claim went over half a million” is like an out-of-tune violin. Or, perhaps the cadence of “You had four specific claims this year” will bring a tear to my eye. Even better and more popular, let’s all sing a bar from the familiar song “I know you didn’t have any claims, but the industry overall has been hit hard.”
You know what I want out of reinsurance? I want a whole freaking symphony of sounds that makes my heart sing with praise. I want the reinsurer to be a partner. Crazy idea? I don’t think so.
The way the industry is structured now, employers don’t communicate directly with the reinsurer. Why is that? Why, when they review a bid, can’t they offer tips, ideas, and ways to reduce risk for both of us? Why is it that they — the underwriting specialists — can’t tell me which disease management partners they’ve found who have decreased expenses for other employer groups?
I’ve discovered that many reinsurers want to be more involved with the employer but can’t. I wished my reinsurer would say, “Wow, you have value-based designs in place, you get a discount!”
I bet that if they had more frequent updates on my claim data, and saw an organ transplant coming, they’d be happy to suggest some transplant programs to offset our costs. Why doesn’t the reinsurance market provide a consultative approach and add value to the employer? I want them to sing in my choir.
I remember an out-of-network hospital claim that called in for pre-authorization to my Administrative Services Only (ASO) provider and was approved. But then, the claimant was just forgotten. No follow-up, no case management.
The member stayed there over two weeks. Even better, they released the bill payment at 100% with no attempt to negotiate it down.
When I asked my ASO (who also handled our reinsurance), why we both had to bear the burden of this expensive claim, their lyrics consisted of excuses, citation of policies, and overall lack of procedures.
Even when the reinsurance is bundled by the same provider, it still doesn’t work to protect mutual interests. Not on the Top 40 Hit List with me.
It’s time for a whole new reinsurance overture — a true partnership that monitors my risk, rewards me for wellness initiatives, and provides me with resources. Then, at renewal time the music will be a slick saxophone that calms my soul. Let’s start composing a new reinsurance rhythm! Are you ready to sing?
Guest blogger Karrie Andes, SPHR, is a frequent speaker on self-insurance, a freelance writer and HR professional in Kansas City. She can be reached at email@example.com.
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