The Open Solution

Now you can communicate with MBA instantly with the touch of a button. Download the free MBA Administrators app from iTunes or GooglePlay and access a host of special features. From the app you can check your claim status, or contact our support team. Secure document sharing will make managing your health benefits simple. Stay informed by following the latest industry news; keeping tabs on company events and important notifications.

MBA's CEO, Phyllis Merrill, announced, "We are so excited to offer the mobile app. We recognize people now live on their phones and tablets. We wanted to make our services available to them around the clock at the touch of a button. What a great way to save time."

Mobile App Features:

Send secure documents to our office.

Login to your membership portal.

Check the status of your claims.

Contact us through email or phone instantly.

Receive important notifications and alerts regarding your account based on your preferences.

Access your member ID card electronically.

View event information.

We have taken all of the extra precautions to ensure that your information remains private and secure, exceeding the standard HIPAA requirements to lock down sensitive data, while taking advantage of mobile technology's convenience, accessibility, and ease of use.

MBA Benefit Administrators is leading the TPA industry to make managing your health benefits easy. Merrill commented, "I love efficiency. People have to have efficiency now. We all want to make the best use of our time. That is the whole purpose of our new app."

Employers Fight Against the Rising Cost of Health Care 

Have you ever wondered why health care is so expensive in the United States?  American Employers pay the highest health care costs in the world.  Employers remain in the dark about why costs are so high and believe they are powerless to stop this trend.While most healthcare professionals say rising costs are due to an aging population, expensive new technology and medications or new government regulations; the truth is that most health care providers are increasing their prices in order to increase their profit margins. The true fundamental flaw in the health care industry is irrational pricing with no motivation to reduce their costs. 

Over the next few months millions of employers will endure medical plan renewals. Most are expecting to see benefits costs to increase substantially.  To avoid massive monthly premium increases many will shop for new insurance carriers as they do every year.  Some employers will follow the popular trend and shift more costs to their employees by increasing premiums, deductibles and out-of-pocket expenses. Employers that continually “rate-shop” or shift costs to employees are not solving the rising cost of healthcare, but are submitting to the health care industry.  

So how can employers fight against paying increasingly unreasonable costs of medical benefits?  They must demand transparency from the healthcare industry.  Employers who are facing renewal should consider health plans that contain the following three cost saving strategies: 

1. ZERO increases to premiums and possibly see premium decreases the following year.   2. The ability to increase benefits and add more primary care series with no increase in out-of-pocket charges for members. 3. The capability to audit and re-price every medical claim for billing errors and fraud, to guarantee transparency and reasonable prices from the healthcare industry.

Fortunately, The Open SolutionTM  empowers employers to fight back and take control of their health plan costs.  With The Open SolutionTM, an employer on average will spend less per employer on health care than the previous year by incorporating multiple cost saving strategies. These strategies allow The Open SolutionTM has no network requirements, allowing employees to visit any doctor or facility. Below are some examples of successful experiences with these cost saving characteristics in action: • Texas Service Company- Dropped Blue Cross PPO and reduced their premiums by 68%. Additional savings allowed the company to provide free vision, dental, and life insurance and establish a free medical clinic on-site for employees and their dependents. • Large Western Tribe- Reductions were so dramatic that rates were lower in 2014 than when they were in 2008. Saving millions of dollars allowed the tribe to add more participants to the plan. • Home Furnishings Company – Experienced a 40% savings the first year after implementing new plan ($2.5M reduction on previous $6M expense). With 180 stores in five states, the company’s 1,800 employees are free of PPO network restrictions. Eliminating the burden of assembling a multi-state network has greatly simplified the health insurance plan and reduced costs. The Open Solution™ savings example: Reduced $140K hospital bill to $12K – a savings of more than 90%.

The Open Solution™ has a track record of reducing employer medical plan costs. Many employers utilizing The Open SolutionTM  experience renewal season differently! Many of them will tell you that the budget has been stable or deceased, which allows them to keep their money and attention on their business. 

Why do you continue paying outlandish premiums for your insurance plan? Why do your premiums go up every year? What if there was a way to keep employee premiums down without lowering benefits or raising deductibles? You need a smart alternative to the typical PPO network discounts that hardly make a difference in terms of cost savings.  What if instead of “top down discounts” on your bill you were paying a fair and reasonable price from bottom up? This would bring charges for things like MRIs, medical supplies, and procedures such as dialysis to a more reasonable level.

The Open Solution™ obtains massive savings off of billed charges. With the help of ELAP Services we protect you and your precious healthcare dollars by auditing and re-pricing each and every medical facility bill that contain exorbitant charges. We advise our clients to purchase health care in the same manner they buy everything else: with transparency and a clear relationship between cost/value and price.

ELAP Services analyzes bills based on criteria such as what hospitals bill Medicare patients. Using a hospital’s own financial filings, ELAP isolates billing errors and outrageous charges for small items, such as $75 gauze pads. When faced with this documentation hospitals accept the lower payment most of the time.  ELAP also offers a co-fiduciary relationship to provide legal defense if balance billing occurs, and defends plans and individuals from unfair and illegal collection practices by medical facilities.

Check out what happens to a hospital bill after ELAP Services audit and re-prices it:

Unfortunately, most PPO discounts offer minimal savings. Usually PPO networks save you an average 25% off the billed amount. This means if you were to take same bill from above you would have paid $9,583.50 under a traditional PPO network discount. By having the bill audited and re-priced we were able to save the company 84% off the billed amount or $10,709.22.  We dare you to try to find a PPO network discount that will help your company more than our audit and re-pricing services.  

Cut the cost of your Health Insurance Premiums! 

It is health insurance renewal time again. You mull over a couple of options provided by your loyal and trusted broker. Once again your premiums are going up, and will need to make room in your budget for the increase. This pattern of increasing costs is only going to continue year after year. You ask yourself, “Why does my medical health plan cost keep going up?”

For most companies, medical costs are the second largest budgetary expense, next to payroll. What if you could decrease medical costs? You could budget more for advertising, production, inventory, research and development, building space. You name it. The truth is the cost for providing health insurance is also rising faster than salaries.

The following chart, recently published from Frobes , contains the annual increase for health insurance premiums and real personal income.

Each year that health insurance premiums rise faster than income, there is less money to save or spend. Employees are facing higher premiums, deductibles, and co-pays. As a result, Americans may take fewer vacations or save less for retirement. It is estimated that 20% of working Americans will struggle with paying for healthcare related expenses this year.

The sad truth is that no hospital, doctor, pharmaceutical company, insurance carrier, or PPO network is financially motivated to assist you in decreasing your health plan costs.  That’s why the players in health care industry won’t fix cost of providing health care.  If you are tired of waiting on industry or government help, then keep in mind this quote by Dr. James Robinson, professor of health policy at the University of California, Berkeley, “The only way to pay less for health care is to pay less for health care.”

The Open Solution™ is how you can pay less health care without disrupting the benefits to participants on the group plan. The Open Solution™ is the collaboration of multiple high-powered cost containment strategies.  These proven approaches will substantially reduce the costs of providing health benefits to your employees. The plan gives organizations control over the price they pay for healthcare and employees the freedom to choose which providers and facilities to use.

The Core Cost-Containment Strategies • The Open Solution™ includes partial self-funding with stop-loss insurance for control and protection. • We replace network discount plans with the open solution auditing and re-pricing formula for massive savings, which allows you to see any doctor or visit any facility. • Medical management and ongoing support reduces the cost of care and prevents emergencies for employees with chronic conditions. • An experienced third-party administer coordinates all the pieces.

The results with The Open Solution™ has been ending annual rate increases, and in most cases lowering premium rates without reducing any benefits.  Here are some specific examples with our clients:  

• Texas Service Company- Dropped Blue Cross PPO and reduced their premiums by 68%.  Additional savings allowed the company to provide free vision, dental, and life insurance and establish a free medical clinic on-site for employees and their dependents.

• Large Western Tribe- Reductions were so dramatic that rates were lower in 2014 than when they were in 2008. Saving millions of dollars allowed the tribe to add even more participants to their plan.

• Utah Call Center – Insuring nearly 100 employees the company switched to The Open Solution™ from a fully insured plan. Medical cost savings are exceeding 25%.

                     Busting 3 Big Myths of Self-Insured Health Plans 

Many companies have evaluated the increasing premium costs associated with their group medical insurance programs and have looked for ways to improve cash flow and economize on the budget for employee benefits.  This has given rise to partial self-funding and insured stop-loss managed platforms. Any company that is not using this type of a plan is probably spending a great deal of money unnecessarily.

The concept of a partially self-insured platform is to eliminate or substantially reduce some expenses – most notably the profits made by big insurance companies.  Most of the myths concerning Self-Insured plans help big insurance companies and their agents keep business on fully insured plans. Remember the annual premium increases reward the insurance company, the agent or broker that sells it to you.  

Too Risky- Properly designed plans with adequate stop-loss reinsurance policies to limit liability, create a functional “fully insured” plan.  

Too Small- Stable companies of 50 employees have successfully managed and thrived with self-insured health plans.

Too Confusing- Did you know that roughly 100 million Americans are covered by their employer’s self-insured health plan? 57% of all health benefit plans in the United States are self-funded. So obviously there are plenty of people who understand well enough to reap the rewards of this type of program.

                       The Open Solution = No More PPO Networks!

Are you tired of worrying about PPO networks? Does your insurance cover you across the nation? How would you like to include all employees’ doctors as part of your insurance? What if you could do away with this nonsense once and for all?

PPO network restrictions could become a thing of the past for you and your employees !  One of the biggest frustrations you have as a plan sponsor is the rising costs of premiums and the lack of choice for all employees. Many employees are forced to go to providers they may not be comfortable with just to avoid out of network penalties.  In fact in order to get lower premiums you may be forced to accept smaller and more limited provider networks.

You should be able to choose the best provider that you are most comfortable with and The Open Solution™ makes it possible to do just that … in fact while saving you money! The Open Solution™ allows you to have the following:

•Unlimited access to providers with no network requirements

• No out of network Penalities – use any facility – Open Access

• See any provider you choose – use any facility in state or out of state

• Intelligent customized plan designs

Employers need a smart alternative to the typical PPO plans that barely scratch the surface in terms of cost savings.  What if instead of “discounts” on your bill you were paying a fair percentage of profit from the bottom up? The Open Solution’s™ audit and re-pricing method obtains savings which dwarf typical PPO discounts. It protects you and your precious healthcare dollars which allows you to see any doctor, or be treated at any facility across the nation.

                        The Open Solution = No More PPO Networks!

Are you tired of worrying about PPO networks? Does your insurance cover you across the nation? How you like would to include all employees’ doctors as part of your insurance?  Are you afraid to change insurance companies because they use a different network?  What if you could do away with this nonsense once and for all?

PPO network restrictions could become a thing of the past for you and your employees and what a cause for celebration!  One of the biggest frustrations you have as a plan sponsor is the rising costs of premiums and the lack of choice for your employees.  They are forced to go to providers they may not be comfortable with just to avoid out of network penalties.  In fact in order to get lower premiums you may be forced to accept smaller and more limited provider networks.

You should be able to choose the best provider that you are most comfortable with and The Open Solution™ makes it possible to do just that … in fact while saving you money! The Open Solution™ allows you to have the following:

•Unlimited access to providers with no network requirements

• No penalties while out of network – use any facility – Open Access

• See any provider you choose – use any facility in state or out of state

• Intelligent customized plan designs

Employers need a smart alternative to the typical PPO plans that barely scratch the surface in terms of cost savings. What if instead of “discounts” on your bill you were paying a percentage of profit from the bottom up? The Open Solution’s™ audit and re-pricing method obtains savings of up to 79% off of billed charges. It protects you and your precious healthcare dollars which allows you to see any doctor, or be treated at any facility across the nation. 

                           My New Book UNcommon is on Sale Now!

Recently , I decided to join a select group of business experts and entrepreneurs from around the world, along with best-selling author and business development expert Brian Tracy, to co-write the book titled, UNcommon: Common Sense but Uncommon Knowledge from Today’s Leading Entrepreneurs and Professionals to Help You Lead an Extraordinary Life of Health, Wealth and Success.

In the past 30 years, I have been involved in group administration of partially self-funded medical benefit plans.  It has never ceased to gall me how the medical delivery system is set up to thwart the business processes of paying a fair price for medical services. The truth is the purchaser is simply not in control.  Every business owner in America senses they are being gamed, but he or she has absolutely zero control when picking up the tab for one of the biggest line items in their budget.  I strongly believe that employers should be paying for medical goods and services in the same manner that corporations purchase everything else – with transparency and upfront knowledge of costs. 

In this new book, you can read my eight critical steps to take control of your healthcare spending, along with special insights into the history of healthcare, and how the United States came to the place we are now, along with some very personal insights into the development of my passion towards saving money. It didn’t happen in a corporate office, or in the spotlight of educating government regulators, it came on an Idaho farm, before the sun rose as I helped my mother pick peas to earn money for school clothes.

                            Now is the Time to Pay Less for Health Care! 

The unrelenting trend in health plans is a spiraling and unsustainable inflation rate in medical costs.  We all know this and are aware of the outrageous charges to medical bills every day, and usually it’s the employer who ends up paying for health care.

“American employers have arguably become the sloppiest purchasers of health care anywhere in the world.”  – Uwe E. Reinhardt, economics professor at Princeton University

Employers need a smart alternative to the typical PPO plans that barely scratch the surface in terms of cost savings.  What if instead of “discounts” on your bill you were paying a percentage of profit from the bottom up?  No more $1,000 toothbrushes, $20 tissues, or occupation and speech therapy for a newborn (true story).  No more outrageous charges for MRIs and other tests and procedures like dialysis, radiation, etc.  

Dr. James Robinson , Director of Health Policy, University of California Berkeley said,  “The only way to pay less for health care, is to pay less for health care.”

The Open Solution™ obtains savings of up to 79% off of billed charges. We protect you and your precious healthcare dollars by auditing and re-pricing claims with exorbitant charges. This allows us to make some of the best employer’s health plans that include:

Access physicians through a national network – see any provider you like

Fair Claims pricing – claims are audited for extreme mark ups and re-priced

Co-fiduciary Protection

Stop-loss coverage that results in significant premium reductions

We believe that employers should be paying for medical goods and services in the same manner that your corporation buys everything else – with transparency and upfront knowledge of costs.

                           Benefits of Case Management 

Let’s face it, everyone puts off going to the doctor – and it can catch up with us.  We also know that if we manage chronic issues carefully we can avoid the size and frequency of problems – and claims – down the line.

 Undoubtedly there are employees in every organization that have chronic health challenges that require regular care.  Chronic conditions can be costly – just 4% of claims exceed $10,000 but claims for more than $10,000 account for 60% of expenditures. Controlling these costs is a big deal!.

 According to many employers, their biggest problem is escalating insurance premiums and higher deductibles being forced on selected high-risk members even though they are in a qualified group.

 The American Medical Association Cost Statistics, states that keeping just one congestive heart patient out of the emergency room for just one visit could more than pay the entire annual UR premium for a company of 100 insured Employees.

 Pro-active medical case management helps to prevent costly medical stays and procedures by utilizing nurse case managers throughout the continuum of care. Ongoing support reduces the cost of care and prevents emergencies for employees with chronic conditions, which saves money for employers on their health insurance premiums.

 In 1991 I founded Critique, a medical management organization, to provide utilization review, case & chronic disease management along with an abundant set of medical management services, to employee benefit plans. I have helped employers enhance employee health & wellness and reduce absenteeism while controlling costs via a proprietary process that monitors and measures healthcare providers and employee compliance at every level of care. Critique acts as an advocate for patients insured by our clients. All employee medical benefit plans have benefited from the services that we provide without shifting costs to the employee or reducing their benefits.

 I recently created The Open Solution™ that uses case management as one of its multiple cost containment strategies to make employee benefit plans more affordable for employers. It gives a solution that will save money, and provides better care to the employees that need it the most.  By providing Nurse Case Managers for the continuum of care employees can receive:

 ·         Preventative consulting

·         Episode Management

·         Health Maintenance consulting

·         Ongoing support and assistance

 For employees this could be a whole new world for them.  They don’t have to suffer the usual delays; sitting on hold for the doctor’s office to make a visit, arranging their day around appointments or hanging out in waiting rooms just to get seen for a quick update or checkup or ask a question.

 Instead they can check in with their Nurse Case Manager to keep her updated on their condition, get advice or receive monitoring equipment for home use. This approach can help keep symptoms controlled and maintain their lifestyle in the way they want instead of revolving it around the doctor visits..

Substantial Healthcare Savings

We have told you we save our clients money, but we thought we had better show you the substantial healthcare savings that The Open Solution provides our clients. Here is one example how our customers from across the country, experience  90% of the invoiced services, to 50% off the services rendered. Our audit and re-pricing formula proves we can give you a larger discount than regular PPO discounts.  

Substantial Savings  

We have told you we save our clients money, but we thought we had better show you the substantial healthcare savings that The Open Solution provides our clients. This is just an example of  how customers from across the country, whose savings ranges from nearly 90% of the invoiced services, to 50% off the services rendered. The big question is does your PPO discount save you this much?  

Home Furnishings Company – Experienced a 40% savings the first year after implementing new plan ($2.5M reduction on previous $6M expense). With 180 stores in five states, the company’s 1,800 employees are free of PPO network restrictions. Eliminating the burden of assembling a multi-state network has greatly simplified the health insurance plan and reduced costs. The Open Solution™ savings example: Reduced $140K hospital bill to $12K – a savings of more than 90%.

Phyllis Merrill will be debuting her chapter in “Uncommon” at the 2015 Benefits Technology. Her chapter discusses how to take control of healthcare spending. If you want a signed copy and to talk to Phyllis, be sure to visit her at the summit.