Not wanting to rock the boat at contract renewal time, benefits managers can sometimes miss some big picture savings that can come from renegotiating their company’s healthcare plan audit rights. What they may not realize is that by blindly agreeing to standard language in their services agreements, companies are typically limited to random sample audits. This language restricts the self-funded employer from reviewing all their paid claims for errors, overpayments, and fraud and abuse.
With a 1 to 3 percent of total claims error rate, a cost that self-insured employers must cover out of their own pockets, companies cannot afford to give up their rights to audit every claim in the name of maintaining the status quo with the payer.
In fact, the BenefitsPro article, 5 Misconceptions Employers Have About Their Benefits Plans, lists the No. 1 misconception as “the insurer has my best interests in mind.”
“Just because an insurer is working with you doesn’t mean they’re working for you. Misaligned incentives are a common factor driving up health insurance costs for employers. Insurers make more money as your premiums go up, so there’s no real incentive for them to work to bring your costs down instead,” writes Jim Blacheck, co-founder of The Benefits Group.
Agreeing to random sample audits instead of a targeted, comprehensive audit can cost employers hundreds of thousands of dollars each year. Cure the Benefits Blues by updating your services agreement to include a 100% comprehensive annual claims audit.
Every Claim. Every Possible Dollar.
To learn more about our approach to healthcare claims auditing, visit Healthcare Horizons or contact us at hhadmin@healthcarehorizons.com to discuss a free healthcare claims audit assessment.
Randy King is president of Healthcare Horizons Consulting Group, Inc. – performing healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.
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