Insurance carriers shouldn’t deny employers data access

The U.S. economy is improving, but businesses still face numerous threats. At the top of this list is the outrageous cost of employer-sponsored health insurance. The average annual employer-sponsored family health premium reached $24,000 in 2023, a 50% increase over the past decade, according to the Kaiser Family Foundation. These high costs suppress business profit margins and workers’ wages.

At Lincoln National Bank, which has 115 employees in Central Kentucky, we’ve shown that businesses have the power to reverse runaway health benefits costs. Like many companies, we were facing annual double-digit increases in health insurance costs. In 2019, we revamped and took control of our company’s health plan by contracting with price-transparent providers. Since then, we’ve cut plan costs by 50%. We shared these savings with employees by cutting premiums and deductibles in half.

Price transparency prevents health care providers from overbilling

The first step we took was getting rid of our overcharging health insurance carrier and pharmacy benefit manager. They were blocking access to billing claims data we needed to understand which providers were overbilling. Armed with claims information, employer health plans can audit their health plan costs, analyze charges before paying provider bills and prevent overpayments. By being well-informed, employers can better design health plans to encourage employees to get the care they need at the highest quality and lowest price.

By analyzing our claims data, we found our health plan was being charged $3,300 for MRIs that can be acquired for $400 and $11,000 a month for a medication that can be acquired for $300. We also identified a bundled surgery for 30% of our previous insurance carrier’s price.

Many employers are being denied access to this critical billing claims data by their health insurance companies. Some major employers have even had to sue their insurance carriers after finding they’ve been significantly overcharged and blocked access to this pricing and payment information. Kentucky Rep. Brett Guthrie, chair of the Energy and Commerce Committee’s Health Subcommittee, presided over a recent hearing in the U.S. House of Representatives revealing these problems and discussing the importance of healthcare price transparency.

When consumers don’t know actual health care prices, costs vary wildly due to a lack of market pressure. Prices for common medical services in Kentucky fluctuate by an average of 31 times, depending on the hospital and insurer, according to a recent study by PatientRightsAdvocate.org.

No employer would tolerate paying 31 times more for vendors or supplies than their competitor down the street. Nor should they tolerate paying 31 times more for the same health care.

Legislative support is needed to hold the health care industry accountable

Bipartisan congressional price transparency legislation can make it easier for other employers to follow our lead. House and Senate negotiators are currently working on reconciling their respective healthcare price transparency bills into a final package that can be included in one of the upcoming spending bills. It’s critical that the final legislation include real-time employer access to digital claims data as receipts of payment so we can easily compare prices to avoid overbilling and hold the healthcare industry accountable. The Senate version, the Health Care PRICE Transparency Act 2.0, includes this vital provision.

Congressional leadership, including Rep. Guthrie and Sen. Mitch McConnell, will be critical to ushering in this bipartisan legislation that can empower employers with a competitive healthcare marketplace for the first time.

Our health plan has made contracts with ambulatory surgical centers, centers of excellence and imaging centers at fractions of what big hospitals charged under the previous plan. This model allows the bank to cut out the countless middle players, including claims processors and adjudicators, that drive up health plan costs and hide necessary information. Our employees now enjoy primary and ancillary care for free and prescriptions for $1.

Not every employer will pursue such radical rethinks of their health plans. But with some help from Washington, they will soon be able to access their claims information to begin making cost-conscious decisions that protect profit margins and employee wages, boosting the American economy in the process.

Griffin Meredith is Secretary of the Board at Lincoln National Bank.

PROVIDED Lincoln National Bank.