Total Knee Replacement
$24,500
Veritas Surgery
$75,000
Insurance Price
High-Cost Surgeries Can Disrupt the Entire Renewal Story
For brokers and consultants, a few unpredictable claims can change the entire client conversation:
Unpredictable surgery claims
$75,000+ orthopedic episodes
$90,000+ spine procedures
Fragmented facility and professional billing
Out-of-network and member disruption risk
Stop-loss volatility and renewal pressure
Surgery spend can drive a disproportionate share of plan volatility
When one orthopedic or spine claim hits, advisors need more than an explanation — they need a plan-compatible solution they can confidently bring to the employer.
A Surgical Carve-Out Built for the Advisor Ecosystem
Veritas helps brokers and consultants bring employers a practical way to control surgical cost volatility without replacing the health plan. We use transparent bundled pricing, typically 40–60% below network rates, with a defined maximum cost per case — no surprise bills, no layered facility charges, and no financial ambiguity.
The model is designed to work alongside self-funded and level-funded plan designs, coordinate with TPAs, support stop-loss conversations, and keep the advisor central to strategy, implementation, and client communication.
Typical Network Path
$75k–$120k total knee episode
Fragmented billing across providers
Undefined employer exposure
Carrier/network-driven pricing
Stop-loss questions after the claim
Member subject to deductible and coinsurance
Veritas Surgery
$24,500 bundled surgery price
Single transparent episode price
Defined maximum employer cost per case
Physician-led regional surgery model
Predictable claim and renewal modeling
Optional member incentive structure
The result: measurable savings, cleaner renewal strategy, reduced surgical volatility, and a stronger advisor-led solution for employer clients.
Discuss Client Scenario
Designed to Fit the Plans Advisors Already Manage
Give clients a 2–5x lower-cost surgery option
Built to work with:
Self-funded employers
Level-funded employers
Independent TPAs
Benefits brokers and consultants
Stop-loss partners
Advisor support includes:
Sample plan document language
TPA coordination support
Incentive design frameworks
Stop-loss strategy alignment
Client-ready savings modeling
Modeling Notes:
Actual claims, utilization, and savings vary by plan year.
Assuming 50% savings compared to insurance rates.
Industry benefits data shows avg. employer-sponsored premiums of ~$9,300 annually per individual. With a 1.7–2.2 covered lives per employee, self-funded plan modeling estimates costs in the $7,000 per member per year range.” KFF Employer Health Benefits Survey.
Typically 15% of all employer healthcare spend is on orthopedics or spine procedures. Segal.
Advisor-Led Implementation Can Stay Simple
1
Review claims and renewal exposure
We review recent claims or renewal pressure points with the advisor, focusing on high-cost musculoskeletal procedures — knees, hips, shoulders, and spine. The goal is to identify where surgical volatility is affecting the client and quantify a direct bundled alternative.
2
Model savings and plan fit
Using transparent bundled pricing, we model projected cost differences versus current network rates and clarify how the carve-out can fit the employer’s self-funded or level-funded structure.
3
Coordinate TPA and plan documents
We provide sample plan document language and coordinate with the broker, consultant, and TPA to implement a clean surgical carve-out alongside the existing network while defining maximum cost per case.
4
Support employer rollout and incentives
Advisors stay central to the employer conversation while Veritas supports rollout language, employee incentive frameworks, and utilization guidance that preserves choice while improving plan-level savings.
This is not a replacement network.
It’s a broker-ready risk-control strategy.
