A Unique Approach

Cost Plus Advisors, LLC is an innovator in cost containment for self-insured employer groups. We help company leaders exercise the same fiscal discipline over their health plan that they apply to all areas of their business. Our focus is not typical.

Think about it:

  • If claim costs are the largest expense in your plan, shouldn’t you try to reduce the “cost” of claims?
  • What if a focus on claim cost reduction resulted in carriers reducing stop loss premiums charged?
  • Have you ever done a line-by-line audit of hospital claims to eliminate errors and overcharges prior to payment?
  • What if hospitals were required to annually list their cost of providing services, verified and certified by their CFO? How could this information be used to reduce the cost of your plan’s claims?
Billed Charges
Cost with PPO
Cost with Cost Plus Advisors

“One of my friends is covered by CIGNA through Schlumberger. His outpatient surgery total cost after CIGNA discounts was over $19,000. At the Surgery Center Of Oklahoma Surgery Center the price all in would have been $8,210. Over a 50% savings vs. the Plan cost with CIGNA. The news clip states that the Center does not take insurance and that the price was a cash up front price.”

Our Cost Plus Model incorporates this center and over a thousand similar centers across the country. Our Model coordinates the care with the patient and one of these centers and pays the center up front to obtain these prices. We recommend a member copay (anywhere from $0 to $500 based on your objectives) vs. the normal deductible/coinsurance for utilizing one of these centers, saving both the employee and Plan significant dollars.

A Broken System

The need for network contracts (and their discounts) is a misconception. The facts are simple. Network contracts are costly and prohibitive. Our solution is proven and provides plan sponsors with niche expertise including prepayment audits of facility bills, fair and reasonable facility reimbursements and fiduciary support.

Discounts don’t work. To offset new discounts hospitals simply raise their rates, unchecked and unreviewed. Our model emphasizes reimbursing providers on a cost plus basis, not a discount off of billed charges. Our mission is simple – to ensure that our clients pay fair and reasonable prices for their medical and prescription claims. By focusing on reducing the cost of claims, reinsurers respond with lower premium costs.

The Growing Costs of Medication

Pharmacy costs represent a growing percentage of health plan spend. Despite patent expiration, the cost of both generic and name brand drugs continues to rise. The pharmacy industry is increasing the release of expensive specialty drugs. Pharmacy Benefit Managers (PBMs) are the “middle men” in this category of spend. Most PBM contracts are convoluted and not written in the best interest of the plan sponsor. They are not written to protect Plan assets.

At Cost Plus Advisors we improve contract language and align it with your needs to decrease your spend by up to 25%. We also take a dual approach to pharmacy vendors: Domestic Pharmacy Benefit Manager (PBM) with a supplemental International Mail-order benefit.

Here is an example of savings:

MedicationQuantityUS PBMInternationalSavings% Saved
Advair 250180$815$249$56669%
Crestor 10mg90$563$126$43777%
Celebrex 200100$700$116$58383%
Nexium 20mg90$648$138$50978%
Xarelto 20mg90$861$377$48356%
Gleevec 400mg90$28,184$13,136$15,04853%

Note: Internationally sourced name-brand prescriptions are in the original manufacturer’s sealed packaging.  These are exactly the same drugs from the same manufacturers as purchased in the U.S.