Posted by admin | Posted in Employee Wellness, wellness program | Posted on 02-12-2010
Incorrect billing from health insurance carriers is more common than you may think. The average plan sponsor can get overcharged by 5 percent a year, as reported by brokerage and consulting firm Corporate Synergies Group.
Like most organizations, insurance carriers rarely keep perfectly up-to-date records on their patrons. As a result, plan sponsors often get charged for individuals who shouldn’t be covered on the health plan. Here are two areas to watch –
Claims versus enrollment
It’s common to have cancelled workers still in the carrier’s claims eligibility system – even after they’ve been taken off your enrollment list.
Reason – Many carriers use separate computer systems for tracking enrollment and claims – and the two systems use different technologies that don’t “talk” to each another.
Carriers have no incentive to upgrade their systems, according to CSG president Eric Raymond, because doing so would cost the insurers money.
Leaving things as is, carriers simply charge patrons when they put through claims for ineligible workers and dependents.
That’s why an annual claims audit is a must – That way, you won’t get charged fees for claims the carrier accidentally put through.
Even if your firm outsources the work (it’s a rather time-consuming task when performed in-house), you’ll generally see several percentage points of savings on your total healthcare costs.
Dependent eligibility
Poor carrier record-keeping also can be the cause for employees’ ineligible dependents not being taken off the enrollment files.
Few carriers have systems that automatically integrate with your Payroll department and your current enrollment forms (including the electronic “employee self-service” kind). Instead, data entry people employed by the carriers input the information in the vendors’ system.
Human error by the carriers’ workforce costs plan sponsors another several percentage points. Solution – annual dependent audits.