With the waters of healthcare becoming murkier every day, employers and employees abdicate many of the cost-auditing responsibilities regarding their healthcare to their insurance company. Unfortunately, placing this level of trust in your company’s health insurance carrier leaves the proverbial fox to mind the hen house.
Those who purchase health coverage through a commercial provider mistakenly believe their insurance company is actively advocating for them and monitoring the costs incurred for healthcare services. While this is far from the case, the shocking part of this reality is that the insurance companies are forcing you to pay more than you should for your company's coverage.
Benefits of Self-Insured Plans
A self-insured health plan can reduce healthcare premiums for your small business by reducing overhead and other management costs charged by big insurance plans. When you have a third-party administrator like Group Management Services manage your self-insured plan, you ensure your employees receive everything promised to them in their plan and limit you from spending more money than anticipated.
Negotiate prices: Insurance companies are billed by the hospital based on what the hospital thinks they should charge for their services. On the other hand, TPAs look at what the hospitals pay Medicare – which is often considerably less than what the hospital would bill to an insurance company - and negotiate healthcare costs from there. This can have significant impact on healthcare costs (in your favor). To learn more about this business model, I encourage you to read this article from the New York Times about the “$1,000 toothbrush.”
Eliminate Price Secrecy: The practice of provider and hospital consolidation in the marketplace creates an uneven playing field for insurance companies to negotiate true cost-savings for their members. A TPA like GMS will underwrite a custom policy for your group so you don't pay for coverage that the group doesn't need and monitors all claims to reduce your financial risk.
Audit bills: TPAs have the resources and knowledge to help your employee check each bill to ensure there is no double billing for equipment or health care services. A TPA can challenge prices for services that are beyond "reasonable and customary," substantially reducing patient bills and keeping your claims down.
Employee peace-of-mind: With the changing landscape of healthcare, you can assure your employees have job security along with quality and affordable health coverage. A TPA’s main concern is you and your employees, ensuring a more personable and attentive service experience.
Increased cash flow: Self-insured plans managed through a TPA brings the control of processing of health claims back in-house, minimizing losses and reducing administrative costs.
Self-insured plans through a third-party administrator like GMS can give you more control of your coverage and help cut costs, while still providing quality coverage to your employees. Interested in how a self-insured plan could help your business? Get a quote now or speak with one of GMS’ TPA experts.