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The monthly agg factors are provided by the stop loss carrier prior to the plan year and stated on the policy the employer signs. These are given as a monthly PEPM number. The annualized aggregate attachment point will fluctuate as enrollment changes month-to-month, but the monthly agg factors will not.

Thank you Marty!

Do it!!!

Hyperbole much? What you don't acknowledge is that employers typically cover anywhere from 60-80% of the premium to offset the cost of health insurance for employees. Second, "when men you like stop speaking" is such an unnecessary dig. What you don't know about Matt and his sister Megan, is that they developed a series of explainer videos to help people better understand their benefits and it's wildly popular among employees. Thanks for being a TH-cam comment warrior rather than trying to make a difference in the real world.

They still have a TPA/ASO managing their medical claims and a PBM processing pharmacy claims. The employer receives claims data like any other self-insured employer, and the only difference in the detail and quality of the claims reporting is dependent upon the administrator themselves. This is true at least in our captives at Pareto, but I cannot state with certainty that other captive managers don't impose some limitations on visibility into claims.

That would be a question for Dr Makary, as I'm not sure! Thanks for asking.

True, but it is that complex, and therefore an advocate can be very useful for people

That's great to hear! I wish you success and let me know how I can help. Find me on LinkedIn at Spencer Smith, CSFS

Dental insurance is essentially a schedule of discounted dental services and not really insurance. Same with vision "insurance". It's weird to me that we separate parts of our body to have different types of insurance, rather than having health insurance cover our eyes and mouth too!

@ totally.

I just dropped my dental insurance. It doesn't pays for nothing. A visit and a cleaning. It's a joke.

@ right. I had to take my 17yo to Tijuana because she needed to be sedated( she has Down syndrome) it was going to cost 30k. We got it done in Tj for 15k. It was outrageous dealing with the insurance. They kept telling us to go to Kaiser and Kaiser kept telling us to deal with dental insurance. Just a crazy back and forth. Not worth it.

This is the most common response I get, but universal healthcare simply means the government runs it and forces everyone to pay into via higher taxes. If you look at the way the U.S. government manages its own budget and debt, what makes you think adding Trillions of dollars a year to that would somehow make it better? The Pentagon has never passed an audit, yet our government running a $4.5T a year, incredibly complex healthcare system is now magically going to be solved because the government is in charge? There are a thousand things I would change about our current healthcare model, of which I cover weekly, but never in a million years would I think the government should be MORE involved. The ACA gave us the elimination of lifetime maximums, the medical loss ratio requirements and prevented physicians from owning hospitals. All three of these changes had catastrophic impacts on rising costs, and this is just one example of government intervention making the system worse.

@ Jesse Ventura is for Universal Healthcare as well Michael Moore and they make a lot more sense. United Healthcare Ceo was gunned down and why did that happen.

Thank you for commenting

Thank you 🙏🏼

It depends. Lasers are not a guarantee and you hear stats that about 50% or more of the time they don't even hit. Whether they bake this into the budget and build into contributions depends on their strategy and guidance from their consultant

My old company Plansight is a great option. There are a few others out there like Ringmaster as well.

I'll make sure to be less annoying for you next time Shannon Grasso 1604.

Well it's got a couple thousand views so 🤷🏻‍♂️

How so? The knee jerk reaction to an imperfect current system is always that if the government ran it, we would save money. My stance, with lots of historical precedent, is any time the government runs something, it becomes less efficient and more expensive. Plus, when you fund it via taxes, everyone has to pay in, rather than private system in which you can technically opt out of.

@@SelfFunded "Medicare for All spending would be approximately $37.8 trillion between 2017 and 2026, according to a study by the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst. That amounts to about $5 trillion in savings over that time. These savings would come from reducing administrative costs and allowing the government to negotiate prescription drug prices." that's just one of the few results if you actually research the issue, even conservative backed studies support it

@@SelfFunded Currently families are paying more with private insurance and copays then they would if it was a single line simply added to their taxes, this also allows for lower class families to have access to life saving healthcare they wouldn't normally be able to afford. Living should not be a class privilege, anyone who argues otherwise is a monster

How so?

@@SelfFunded Thank you for this interview. Pharmacogenetics is far from straightforward to discuss, outside of health care professionals and biomedical researchers talking with each other. You and the interviewee both do a terrific job of avoiding jargon and focusing on the advances that a buccal cheek swab analyzed by a clinical lab reveal now, as well as for the future.

I think as easy example is this: Are cash prices at hospitals often lower than contracted network rates from a carrier? The answer in many cases is yes. Therefore if an individual can get a cheaper rate than a giant carrier for the same medical service, why couldn't a boutique PBM who is focused on lowest net cost and not rebate maximization get a lower price than a Big 3 PBM?

I really appreciate your comment and thank you for subscribing. I’m a casual consumer of a few “bro-casts”, but that’s not the type of show I want to run personally. We have conversations like this one every week, covering a wide range of healthcare issues with brilliant people. Thank you so much for your your support!

It’s true Shawn. We need 10,000 more talented people like Jake working on this issue. You and I talk about this all the time. We need to do a better job of inspiring people to join this fight, and apply their bright minds to the issue that is so big it could collapse the American economy. Thanks for being on the right side of this fight 💪🏼

Looks there’s a typo so can’t quite figure out what you’re asking.

@@SelfFunded sorry. I should have ready how do I get involved in this. Damn auto correct! lol

Thanks for commenting, bro.

The government passed the ACA, which added MLR requirements and removed annual/lifetime maximums. The results of more government intervention on private health insurance has had a catastrophic impact on rising costs. If you want a non-healthcare example look at Musk’s Space-X vs NASA. When the government runs in an industry it is far less efficient. US healthcare is complex and imperfect and I think state/national healthcare makes that infinitely worse, plus it will increase costs. A few years ago the state of CO voted on a having a state run health plan, and 2/3 voted against it because it was going to triple the state’s budget.

@SelfFunded sorry buddy, but the universal healthcare of canada and the UK is far more efficient then ours, people paying 300-500 for medical insurance that barely covers anything

No. I’ve worked with consultants the last decade but I’m not one myself

@@SelfFunded how do I contact you?

Do you have a job? If so, I presume it’s because of capitalism. Even if you work in the public sector, your position is funded by taxes, which are produced by capitalism. Same if you’re unemployed and receiving income benefits. Your computer or phone you’re typing in is because of capitalism. It’s always “muh capitalism” but never a suggested alternative that doesn’t rely on production from private sector. What you’re really crying about is crony capitalism where the public and private sector colluded to enrich themselves. To that end, I agree with you.