The Forensic Examiner Book Review (Summer 2013 Issue): Forensics of a Medical Plan by Randall Childers, Jr.
There are many companies today that desire the ability to continue offering an excellent health plan to their employees. However, with the continual changes to health care law they find their costs continuing to rise and the regulations harder to navigate. There are also so many different choices in plans and business associates that it is difficult to determine the best course of action for the company without diminishing the quality of the plan for the employees. In his 2011 book, Forensics of a Medical Plan, F. Randall Childers, Jr. takes an in-depth approach to examining the types of health benefit plans available, as well as the determining factors a company should consider during the choice of a health plan.
While the author explains several different plans available and the difference between them, his main focus is on the matrix of the self-funded medical plan. He covers the difference between agents, brokers or consultants, third party administrators, and contract administrators. He includes a very beneficial tool in the back of the book to assist in the evaluation of a contract administrator. He also touches on several of the most important considerations that should be taken into account. He uses his knowledge as a licensed third party administrator, employee benefits consultant, life and health insurance agent, and more than 25 years of experience to provide a comprehensive look at these areas. A few of the areas covered are stop loss coverage, managed care, pharmacy benefit management, and out of network repricing and negotiation.
Additionally, he believes that a company should request and analyze specific reports in order to make the best viable decision. This data risk analysis contributes to the ability of the company to ensure that both their employees and the company are receiving the best product available. Mr. Childers does an excellent job of explaining what reports to ask for as well as what to look for in those reports.
This book provides clarity of terms and legalities that are otherwise hard to understand. The medical plan components discussed as well as the tools included should provide a company with the understanding needed to maneuver their way through the labyrinth of medical plans and business associates available.
