Athos Health

Lowering the cost of healthcare for consumers

Let’s imagine. Imagine with me for a second. You decide to get a new car. One of the benefits of working at your company is that they have negotiated prices at both the metro area Mercedes and Ford dealerships, which you’re fine with. The Ford dealership is convenient to you so you go there. You know that no one pays sticker price. There are options, maybe a special order, and of course, your company benefit. After the salesperson determines the best car for your situation, you leave with your new car, but don’t know how much you’…

Google is a great tool for finding suggestions about how to lower your company’s healthcare costs. Do a quick search and you’ll find various ideas about shifting the cost to employees, incenting employees to use generic prescriptions, creating wellness programs, and the like. These programs and ideas attempt to shift the financial responsibility or minimize the consumption of healthcare, and ultimately, attempt to affect your company’s bottom line in this way. An Obvious Omission. Notice, however, that what they notably miss is targeting what we’re getting charged for the healthcare we consume. Whether your company or…

Is it worth it? Still wondering if it’s worth it to recover money spent on errors on your self-insured health plan’s medical claims? Let’s take a look at an example to convince you. Numbers we’ve chosen are not from a particular company. Rather, they’re representative of national trends. The fictional company, “Company A,” has a self-insured health plan. They have 2,000 employees, and their annual spend from their health plan is $10M. On average, 3-5% of healthcare spend covers mistakes made in the medical billing process, and so, Company A spends $300-500K annually on…

In our prior blog, we discussed the importance of asking tough questions of your insurance carrier. There is no doubt: insurance companies examine very carefully what they pay when it comes to their money (i.e. the full-insured model). In fact, they commonly have entire departments, or even hire external experts, to review previously paid claims and recoup overpayments. It’s far less common for insurance carriers to put forth a similar effort to identify errors on claims for self-insured plans, though. The reasoning for this difference is that the incentives just don’t align. Because insurance carriers are paid…

This is the final blog of a three-part series about how employers with self-funded health plans are uniquely vulnerable to overpaying for medical billing errors. (See the first and second blogs.) As we discussed in our prior blogs, neither carriers hired by self-funded employers, nor individuals, are incented to find billing errors. This leaves leaders in a very challenging position, as they are the fiduciaries personally responsible, in a system which has few checks and balances. Growth of Self-Funded Health Plans The number of employers who are self-funding their health plan has grown tremendously over the past decade. In 2006,…