Came in second while pitching a case seventy-two weeks ago.

Prospect bought a group health plan - not from me - that had two features that allowed for lower pricing of the risk:

• certain injectable medicines (expensive) were excluded from coverage.
• the traditional discounted fee for service PPO network was replaced by a no network fixed fee schedule.

At the time, no one in the group was taking the medications the plan proposed to exclude. Owner (aka Punxsutawney Phil) concluded therefore, it wasn’t an issue.

And, the vendor selling the product (aka Thomas Tusser) guaranteed to ‘fix’ (negotiate) those ‘rare’ occasions when providers might charge in excess of the fee schedule.

Guess what.  

Health conditions change; a key employee was diagnosed with MS. Her medications won’t be covered by the plan.

Two other employees are in collection from health systems that balance billed almost double what the plan allowed.

I had covered this topic in my presentation and then wrote Tip # 458.

Therefore, "it” in this case would be, “I told you so!

Tips return January 9^th. Merry Christmas and Happy New Year.