“For self-funded employers, the new year always brings the January sticker shock of ever larger monthly health plan premiums. It feels like what you pay for healthcare is totally out of your control as costs continue to skyrocket.
Even if your healthcare plan for 2018 is already determined, that doesn’t mean that there is nothing you can do to lower costs. In fact, we have a simple step-by-step plan that can save you approximately $600 per employee annually.
HERE’S HOW IT WORKS:
All self-funded health plans are governed by federal ERISA laws – as are public companies under Sarbanes-Oxley law. Both require a fiduciary obligation of employers to ensure the prudent use of health plan assets.
The easiest way to ensure health care dollars are being spent efficiently is to look at itemized bills for all large hospital claims before the bill is paid. Common claims processing does not do this, so you likely overpay. At 40% to 50% of most plans annual cost, hospital fees represent the largest savings potential.
Medical Bill Reviews audit in and out-of-network claims for accuracy, insuring only valid charges are paid and waste, abuse, mistakes, and clinical errors are not paid. This saves the plan serious money and helps meet the fiduciary obligations required of employers by ERISA and Sarbanes-Oxley.
SOUNDS SIMPLE, RIGHT? WHY ISN’T EVERY EMPLOYER DOING MBR?
Employers with an independent TPA and regional PPO can more easily do MBR. The vast majority of BUCA (Blue, United, Cigna, Aetna) ASO contracts have very restrictive “no audit” clauses in their administrative services agreement (ASA) with every employer. The ASA will typically not allow any outside independent claim auditing like MBR. The only way to know for sure is to look at the plan ASA.
Without outside MBR, all employers are overpaying for facility claims since they are being paid with no diligence and no itemized bill- using company and employee money governed by ERISA fiduciary law. There are minstakes, waste, overcharging abuse, and clinical errors on 95% of large hospital claims. Employers would never accept “No Audit” opaque pricing from other suppliers, yet this is the norm in hospital claims payment.”