About

A Quick Reminder

About

Happy Monday!

As a quick reminder, the opinions shared on this blog are my own, and the information included in the Network Contract Watch is drawn exclusively from publicly available sources. Most health carriers treat provider network contract negotiations as proprietary, so it’s natural that publicly available information will sometimes be limited or incomplete.

While I do work in the employee benefits space, this blog is not affiliated with my employer, and I am not authorized to speak on their behalf. I also make a point of respecting professional relationships and confidentiality, which is why this site focuses on publicly sourced information and independent analysis rather than inside knowledge.

I know there’s a lot of anxiety around these topics, and my goal here is to educate and inform. That said, I always encourage readers to “trust, but verify.” (It truly doesn’t offend me.) I strive for accuracy, but I won’t pretend to be infallible — and I trust my readers to approach this information thoughtfully as well.

Thanks!

Why Try to Make it Make Sense?

About

November included an unexpected upheaval in my personal life, and my (lack of) blog posts here showed it. I’m pleased to report, however, that things have now settled down and that I’m back!

The question is: back to what?

My answer is: the original purpose of this site was to help non-benefits experts understand what’s going on with their employee benefits.

Back when I was in a direct contact role, I lost count of the number of times I explained something to someone and they responded, “oh, that makes sense! I guess I’m just too stupid to figure all of this stuff out.”

I would never let that comment lie. My answer was always the same: no, you’re not too stupid to figure it out. What you are is a/an [insert job title here], not a benefits specialist. Understanding all this is my job, not yours. If I tried to do yours, it’d be something of a disaster.

That’s the first point I want to emphasize to readers of this blog: you are not incapable. You just don’t spend all your working hours in the employee benefits world the way I do — which is entirely appropriate, since you’re supposed to spend those hours on whatever you were actually hired to do!

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Introducing the Network Contract Watch

About

A primary feature of this new blog and web site can be found on the home page and in the top menu: the Network Contract Watch.

Why does this matter?

The vast majority of health coverage plans in the United States — but not all! — make use of a provider network. Provider networks are created by negotiation of contracts between payors (the carriers) and providers (health care professionals). While the ins and outs of provider network contracts are extremely complicated and involve legal professionals, this is essentially what they do:

  • The providers agree to discount their rates for patients who use that payor.
  • In return, the payor agrees to “drive” its members toward these payors, so that they can make up the discounted rates with higher volume.
  • Payors often do this by severely limiting members’ coverage for care that’s received outside the network, up to and including not covering it at all.

There are a number of reasons that provider networks exist, and a full explanation of that would take an entire post of its own. The important part for consumers to understand is that their out-of-pocket costs are always going to be lower for care received from providers in the network, with the difference easily running into hundreds or thousands of dollars.

Thus, network contract negotiations between payors and providers directly impact consumers’ out-of-pocket expenses. That’s you — and your money!

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About Me

About

Hi there! My name is Catherine, and I am an employee benefits specialist. I’ve been in this field, in one way or another, since 1996.

Right now, I’m working as a product specialist for an independent, nationwide general agency. In the past I’ve worked as a benefit specialist in government and in corporate human resources offices. I was also an account manager for small group retail agencies while living in Georgia. In other words, I’ve encountered and experienced administration of employee benefits from several different angles.

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Welcome!

About

Have you ever looked at something from your employee benefits package and thought, “But what does this mean? Can’t they write it in plain language?”

You’re in the right place!

This blog and site are designed to help you translate all the legalese and corporate-ese into plain language that anyone can understand. The site also tracks carrier network contract negotiations.