Corporate Wellness Blog

Incorrect billing from medical insurance carriers is more common than you might think.  The typical plan sponsor can get overcharged by 5% a year, as reported by brokerage and consulting firm Corporate Synergies Group.

Like most corporations, insurance carriers rarely keep perfectly up-to-date records on their patrons.  As a result, plan sponsors often get charged for people  who shouldn’t be covered on the health plan. Here are two areas to watch –

Claims vs. enrollment

It’s common to have terminated employees 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, as reported by CSG president Eric Raymond, because doing so would cost the insurers money.

Leaving things as is, carriers simply charge customers when they put through claims for ineligible personnel 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 ordinarily see a few percentage points of savings on your total health care 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 individuals  employed by the carriers input the information in the vendors’ system.

Human error by the carriers’ personnel costs plan sponsors another several percentage points. Solution –  annual dependent audits.