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Stop The Lunacy

With many employers in the midst of their healthcare renewal, I wanted to again take the opportunity to educate employers that a better path with far better results really does exist when purchasing healthcare.

I will use a bit of satire to highlight a few hypothetical everyday purchasing situations that most people would deem completely unacceptable, yet when purchasing employer healthcare, they are widely accepted as the norm.

This is what we refer to at Andus as the “Status Quo”.

  1. You own a company with 90 employees and 20 of those employees have corporate American Express Cards – At the end of the month you receive a billing statement from American Express that has one line item on it that states “You Owe Us $50,000” There is no supporting detail or documentation of purchases that were made. No categories broken down by spend. An employee could have purchased a $5,000 dining room set at a local furniture store for his/her home and you would have no idea this even occurred. All the bill says is you owe us $50,000. I’m sure without a doubt you would angrily call American Express and demand detail and their response would be “I’m sorry but we are not obligated to provide you with that info, it is proprietary to us”

Sounds insane yet it happens every day to employers that have fully insured programs with major insurance carriers.

The carrier owns and controls all of the relevant data regarding the key cost drivers in your plan and they choose whether or not to share it with you and if so what format.

  1. You head over to your local car dealer because you are in the market to purchase a new car and there is a big sticker in the window of the car that you want that states that the cost of the car is $40,000 – That’s it, there is no base price listed plus prices for all of the add on features. Obviously puzzled, you walk into the showroom and ask the sales person, “why does the sticker in the car window only have the price and no other information?” to which the sales person replies “well the car has some pretty expensive features on it, but unfortunately we can’t tell you what they cost”

Sounds crazy, but yet again it happens every day to fully insured employers. To further complicate matters, the insurance carriers give you erroneous pricing through PPO, HMO, and POS platforms.

In many cases employers have 2-3 plans that are really disguised as one plan and yet they pay a significant difference in price for each plan. Getting back to the car analogy, the consumer now controls the purchasing process.

They know what car they want, they know the cost of the features they want and they know what they want their monthly payment to be before they ever even visit a showroom. In fact car dealers when pressed will tell you, they make very little money when selling a new car.

Educated buyers of healthcare can experience many of the same advantages.

  1. Your CPA or tax preparer gets a raise or a bonus if you pay more tax to the IRS- As outlandish as that may sound, this happens every day with Brokers in the benefit world. However, the employer and employee typically never see the “hidden” compensation as it is often paid in the form of bonuses and “overrides”. My goal is not to bash Brokers or anyone attempting to earn an honest living. However, in a transparent world, you would fire any vendor or service provider that consistently delivered a product or service that year in and year out cost more yet offered less features.

Also important to note, there may be employers reading this that are fully insured that say we are receiving  our data because we have more than 100 employees on our plan.

Unfortunately, that data is not only limited in scope but also misleading and presented to you in a way that supports the insurance carrier’s objective which is for you to PAY MORE!

In summary, as long as employers continue to allow the carrier to own and control their medical and pharmacy claims data, they will continue to be faced with a host of bad decisions all in a futile attempt to mitigate annual increases.

On the other hand, if you desire a different path where control, transparency, and cost containment rule the day, please reach out to me.


Anthony Martinelli – President

Andus Health Benefits

[email protected]

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