Dorothy M. Cociu, President, Advanced Benefit ConsultingDorothy M. Cociu, President
Benefits administration, or the process of creating, managing, and updating an organization’s employee benefits programs, is complicated. The complexities have quadrupled with the advent of new laws and regulations, including the ACA Transparency in Coverage (TiC) and CAA Transparency rules and No Surprises Act rules.

Employers are today required to post Machine Readable Files (MRF) for in-network provider rates, out-of-network allowed amounts and billed charges, as well as negotiated rates and historical net prices for covered prescription drugs. Undeniably, these rules will likely be good for employers and employees in the long run, but as of now, employers are confused.

This is where Advanced Benefit Consulting (ABC) makes a world of difference. Since 1995, the employee benefit consulting firm and health insurance agency has set the mission to help employers offload the burden of employee benefits and focus on their business. ABC is the true benefits administration and benefits compliance partner that helps clients offer better benefits so that they can attract and retain the best employees for the long term.

“Our biggest differentiator is the experience that we have. We understand the complexities of benefits administration, the needs of the employers, and the administrative limitations and abilities. And this knowledge is crucial to tailor the best solutions for our clients,” says Dorothy M. Cociu, President, ABC.

Whether employers are using a TPA for administration, an ASO provider, or just using a system like Ease for online enrolment and tracking their ACA reporting needs, ABC understands the complexities and the difference from one to the other. This expertise and insight go way above the normal scope of an insurance agent.

More than a Health Insurance Agency/ Broker Firm

To ensure optimum outcomes for clients, Cociu takes the time to read through every detail when new laws are signed and regulations and guidance are released.

Cociu highlights the verbiage, goes back and reviews it again, and finally talks to her attorney about how she’s interpreting it, and they compare notes. Then she does webinars or seminars on these topics, sometimes by herself and sometimes with her attorney, and writes detailed articles on them. By the time ABC has the webinar or seminar, its clients have already read the articles, which gives them the time to absorb the information and try to understand at least the first layer.

Many of these articles are later published in multiple insurance industry and human resources magazines. This multi-step process has worked well for ABC and its clients over the years. Cociu now often have her clients responding to questions in meetings with bosses and other decision-makers, showing their depth of knowledge.

“Honestly, that is the best compliment anyone could give me,” adds Cociu.

Making the Benefits Administration Process Better

ABC recognizes that no two clients are the same; they have their unique challenges and complexities when it comes to benefit administration. Consequently, the company puts effort into understanding clients’ needs and finds creative ways to address them by making the best overall recommendations.

ABC looks at funding options and voluntary/worksite options and sees where clients are lacking in compliance. If they are large enough or self-funded, the company looks at data analytics and past utilization behaviors to predict future trends.
  • We understand the complexities of benefits administration, the needs of the employers, and the administrative limitations and abilities. And this knowledge is crucial to tailor the best solutions for our clients

ABC works with some self-funded clients that use reference-based pricing, which is where claims are paid on a percentage above Medicare rates, resulting in great savings for the client. However, there can sometimes be pushback from providers and frustration from the HR staff.

Because of the No Surprises Act’s new Independent Dispute Resolution process, there are new steps involved in dealing with disputed claims.

In one such case, Cociu was able to walk the client through what the process was, what the TPA was doing, and how the protections in the laws could protect employees from some balance billing situations. Now with the final regulations making clarifications on RBP plans, she was able to fully explain what would happen in the process with RBP plans.

“We have a dedicated team that works on every problematic claim to assist clients through the process, and we work with the advocacy centers or the RBP network to get the claim resolved. The employer really needs a lot of education and tools before they move to RBP. It’s also important to know that it doesn’t work well with certain types of groups. But for others, it can save a lot of money,” says Cociu.

Fortune Favors the Brave

ABC had many goals before the pandemic, and believe it or not, they were able to implement many of them during the pandemic, and some, by luck or by forward-thinking, were launched just prior to the pandemic, which made all of the difference during the trying times. First off, Cociu wanted to do a weekly podcast series, and they started that in 2019. Lucky for her, it was already up and running when the pandemic hit, and ABC was able to grow its popularity during the pandemic with weekly updates, compliance information, and COVID-19 information.

Their on-demand education platform was launched at the beginning of the pandemic, which assisted clients even more. Unlike many players in the field, ABC never perceives benefits administration as a commodity—something to purchase to make your work tasks easier. It impacts an employee and her/his family. ABC enables clients to be more proactive in this regard.