Caller asked, “Can you help?”

Early in November, the January 1 renewal was delivered to a partially self-funded Employer; an increase of just 4%. Not bad.

Over Thanksgiving, a member of the group was diagnosed with cancer. Surgery followed quickly thereafter. When claims started rolling in, the diagnostic codes spooked the stop-loss insurer. They offered to honor (?) the 4% increase, but “laser” the cancer patient. 

That term means just this one member is carved out of the group.

From the website of the national Third-Party Administrator (TPA) involved in this case; “Move beyond rigid, fully insured plans and gain more control over costs.”

Did this Employer know “control” for the Plan he purchased meant dropping sick people? Did the Broker who sold it know?

Maybe everyone knew and it’s a scheme to shift bad risk to ‘Obamacare’; i.e., while this individual has no insurance for the month of January, she’s been enrolled for Marketplace coverage February 1^st.

Was the pitch to the Employer, ‘Lasers rarely happen. We’ll cross that bridge when we come to it.”

Guess what? 

The cancer patient in bubble wrap for 30 days is the Owner’s wife.

For certain, I’m no marriage counselor!!