Athos Health

Lowering the cost of healthcare for consumers

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,…

It can be hard to find mistakes. Medical bill errors are real and costly. It’s well established (source) that roughly 10% of medical bills have errors on them, yet insurance carriers too often don’t find these errors for self-funded healthplans (see my last blog). Efficiency is key to the carrier business, and finding and fixing errors on the medical bills themselves is neither quick, easy, nor profitable. If carriers aren’t finding errors, maybe patients should be responsible for identifying them. After all, the medical bill should reflect what happened between patient and provider. Besides the providers, the…

Insurance is typically straightforward - Pay a little bit now to protect yourself later. If the unexpected happens, your insurance company writes you a check to make you financially whole again. Car, life, and homeowner’s insurance all work this way. Then...there is health insurance. Health insurance has become much more than protection against the unpredictable. It now facilitates almost every aspect of our healthcare system: Where we receive care, when we receive care, and even how much that care will cost. We all need health insurance, but in its current form it has several perverse incentives that work…