Frequently Asked Questions
Everything self-funded employer plan managers need to know.
About Med-Vision
- Unlike brokers who earn commissions from carriers, Med-Vision operates on a fee-only model. We have zero financial ties to insurance companies, TPAs, or PBMs. Our recommendations are 100% independent and driven solely by your data and your best interest.
- We primarily serve self-funded employers with 200 to 10,000+ employees across industries including manufacturing, municipalities, school districts, and mid-market companies seeking independent healthcare cost analysis.
- No. We complement your broker by providing an independent layer of data analytics and fiduciary oversight. Many employers find that our independent analysis validates — or corrects — broker recommendations, ensuring every dollar works harder.
Cost & Value
- Results vary, but our clients typically identify 8-22% in savings opportunities within the first engagement. Common sources include PBM contract renegotiation, network optimization, plan design improvements, and removing unnecessary vendor fees.
Getting Started
- We typically need 24 months of claims data (medical and pharmacy), your current plan documents, stop-loss policy details, and vendor contracts. All data is handled under strict HIPAA-compliant security protocols.
- A comprehensive risk assessment typically takes 4-6 weeks from data receipt. We deliver a detailed report with prioritized recommendations, projected savings, and an implementation roadmap.
- Absolutely. We maintain HIPAA-compliant data security protocols, including encrypted data transfer, secure storage, and strict access controls. We sign BAAs with every client and follow industry best practices for protected health information.
Self-Funding Basics
- A self-funded (or self-insured) health plan is one where the employer assumes the financial risk for providing healthcare benefits directly, rather than purchasing a fully-insured policy from a carrier. The employer pays claims out of pocket and typically purchases stop-loss insurance for catastrophic claims.
- Under ERISA, self-funded plan sponsors have a fiduciary duty to act in the best interest of plan participants. This includes ensuring reasonable fees, transparent vendor contracts, and prudent plan management — areas where independent analytics like ours provide essential oversight.
Services
- A Pharmacy Benefit Manager (PBM) audit is an independent review of your PBM contract and claims data. We verify pricing guarantees, rebate pass-through rates, generic substitution compliance, and identify overcharges or contract violations that cost employers millions annually.
- Population health management uses claims data analytics to identify high-risk members, chronic condition trends, and preventive care gaps across your employee population. This enables targeted wellness programs and early interventions that reduce long-term costs.
- Both. Many clients start with a one-time risk assessment or PBM audit, then transition to ongoing quarterly analytics and annual contract reviews to ensure sustained savings and compliance.
Still Have Questions? We're Happy to Talk
No obligations. No conflicts of interest. Just an honest look at your data.
Schedule a Free ConsultationOr call (813) 962-7436