During my 28 years in the employee benefit industry, health insurance has gone through many changes. I have experienced traditional non-network insurance with deductibles as low as $250, HMO and PPO networks, copays for physicians, ER and urgent care, HSAs, FSAs, HRAs and health care reform. And all came about in an attempt to help control health care costs in employers’ self-funded medical plans.

As the HMO and PPO networks still exist with major insurance carriers and the PPO networks with independent networks, they do not offer the savings they were designed for when first introduced to the market over 25 years ago. These networks feature non-transparent agreements with physicians, hospitals and other vendors for reimbursements that, in most cases, still have the insured being balance billed because the difference between the agreed reimbursement amount with the carrier or network is different from the retail price charged by the provider.

We are slowly entering a new era where employers are demanding new ideas and solutions to reduce claims costs and stop loss premiums. The days of the PPO and HMO networks are slowly becoming as obsolete as the rotary phone, because the current system is just not working.

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