There's a lot of misconceptionsabout the health care and benefits industry. Here are afew.

|

My broker knows what they're doing

From my perspective as an employer, the biggest myths I seeare:

|

1. My broker is working for me. In fact, their contract,compensation, etc is all with the insurance carrier.

|

2. My broker has brought me all of the options to review. Someare not brought due to lower commissions. Some are not brought dueto the brokers not getting outside of the BUCAHs to see what elseis going on.

|

3. My broker knows what they are doing. I met a broker who wasselling Jimmy John franchises two months prior to becoming abroker. To think this guy can help lead a multi-million dollarnegotiation out the gate is crazy. The team is only as good as theweakest link.

|

4. Everyone seems to think it's the other person's fault in thesystem. The reality is the whole system is messed up and everyoneis just maximizing their own self-interest. It's not wrong; it'swhat we all do. We need to change the system.

|

Steve Watson, managing director, Summit Path Group

|

Synonym or antonym?

Health care and health insurance are the same.

|

Chris Corkran, national sales director, National InsurancePartners

|

The government will save us

Medicare for All/single-payer will solve the healthcare/insurance crisis. Considering the issues we've seen withquality and operating within budgets from some large governmentalinstitutions, private-sector ingenuity and innovation are morelikely to provide the needed solutions.

|

Michael Naumann, worksite practice leader, Western US,Guardian Life

|

Obamacare is dead

The biggest myth people believe is that Obamacare (or theindividual mandate) has been repealed. They don't realize thatindividuals are still required to have health insurance, and thatit was the penalty for not having coverage which was removed.

|

Some employers mistakenly believe this means they don't have toprepare their 1094/1095 filings. They find out they are wrong whenthey receive a Letter 5699 from the IRS.

|

Benjamin Davis, VP, Diversified Administration

|

Costs can't be addressed

I think the biggest misconception is that companies can't doanything to control health care costs. The problem is complex andmulti-faceted, but costs can be addressed.

|

Doug Morse-Schindler, president and CEO, HealthJoy

|

Carriers care about costs

In a post-MLR world, the only way publicly traded carriersfulfill their legal duty to maximize profits is if health carecosts to go up.

|

Here's another: If a new drug is approved by the FDA, it wastested on thousands of people, will improve quality of life morethan older drugs, and will be more cost-effective than other drugson the market.

|

Reality: People tend to think that FDA “approval” equates“endorsement.” The standard for FDA approval is that the drug doeswhat it claims and benefits exceed harms for some patients. Thedays of new drugs being miracle cures are far behind us. Only onedisease (Hepatitis C) is now cured by a drug that wasn't available10 years ago.

|

Dave Chase, creator & co-founder, HealthRosetta

|

Cost=quality

The biggest misconception in health care is the inversecorrelation between cost and quality of health care providers.Higher cost does not mean higher quality and higher quality doesnot mean higher cost.

|

Taylor Y. Lindsey, partner, Employee Benefits Consultants,Inc.

|

Self-funding salvation

That going self-insured is a good idea. It's like being in adrought and responding to water rationing by digging your own well.It's modern-day feudalism, where the companies with means gain evengreater advantage over companies with limited means. Any solutionsto our health care crises don't involve fractionalizing it evenfurther. They require making the most of massive risk pools tobring down administrative burdens while freeing up companies tofocus on real, scalable innovations to further transform thesystem.

|

Shandon Fowler, founder and principal,Four8Insights

|

Costs must rise

Health care costs “just go up.” As if it's inevitable. It's adaily battle to combat this myth.

|

Cristy Gupton, founder and president, Custom BenefitsSolutions

|

Bigger is better

That it can't be done better for less than the BUCAHs becausethey are huge.

|

Judi Braswell, VP, business development, Behavioral HealthSystems

|

You don't have to pay

Have you ever heard a health care provider say, “Its OK, this iscovered by your health insurance”? Someone has to pay that bill andit ultimately impacts us all.

|

Jeff Walter, chief information officer, ProfessionalBenefits Administrators, Inc.

|

Who's to blame

Health care inflation cost drivers. I think people unjustlypoint the finger at publicly traded insurance company CEOs,brokers, consultants and physicians. While each cog of the wheelcertainly equates to a percentage of every health care dollarspent, drastic inflation, I believe, is in large part due tohospital system consolidation and big pharma. The increase in costsassociated with these items simply gets passed along to theconsumer via insurance premiums.

|

Ben Crowder, vice president, Cornerstone InsuranceGroup

|

I'm invincible

The biggest misconception is that employer-sponsored groupdisability insurance coverage isn't needed or necessary—whetherit's employer paid or voluntary. Particularly, long-term disability(LTD). What some workers don't understand is that their mostvaluable asset is their ability to earn. Coverage is affordable andsaves houses, protects dreams, and gets injured workers back tohaving a productive lifestyle.

|

Dan Aiello, regional vice president group sales and service,Northern Region, OneAmerica®

|

There's power in numbers

Business owners often assume that if their company were biggeror combined with a bigger group, their rates would be cheaper.While we know that larger numbers help spread the risk, thatdoesn't control the demographics and health risks that exist withinthat larger population; thus, the premiums could actually behigher.

|

Tammie King, principal and senior client executive,OneDigital Carolinas

|

Benefits are an expense

Employers still think of benefits as a liability on the balancesheet, rather than looking at how they can strategically contributeprofitability to the bottom-line revenue of the organization.

|

Based on how employers set up their premium contributions tohigh-deductible health plans and whether they help offset thehigher deductible, this concept can be beneficial for everyone—notjust healthy people. There is an opportunity to implement theseplans, which typically drive a lower premium and allow employers tosave premium dollars, and fund an HSA or HRA while keeping theout-of-pocket expenses lower for employees.

|

Kevin Reid, managing consultant, OneDigitalMid-Atlantic

|

You're locked in for a year

MYTH: We can only change plans during our open enrollment.

|

FACT: You can move anytime—especially if it saves money!

|

Craig Becker, benefits consultant, BeckerConsulting

|

Insurers are on your side

That health insurance companies are negotiating for you toensure that you are getting the best quality for the best price.People believe that without the insurance company helping, you'llpay too much at the doc, the hospital, the labs, the pharmacy, etc.It's mostly, but not completely, untrue. Direct primary care is anexample. DPC docs negotiate for our patients and very often getbetter prices on primary care labs, imaging and most medicines. Ifthe law would allow physicians to own hospitals, we could getbetter prices on that as well.

|

Kevin McGann, MD, owner and founder, Family First DirectPrimary Care

|

Self-funding is about cost control

Myth: Employers self-fund so that they can control cost.

|

This is incorrect, as every employer under a carrier ASOagreement agrees to open up the bank vault and allow money to bewithdrawn without proof or evidence that a service occurred.Brokers roll over for their commission and ignore ERISA risk.Employers solve the problem by passing the risk back down toemployees, who are expected to carry the burden of a broken system.Why would any reasonably intelligent person sign an agreement thatgives you zero control and exposes your company to unlimited risk?Let's stop dancing and demand change. The key is in the data.

|

Dawn Cornelis, co-founder, ClaimInformatics, LLC

|

BUCAH knows best

MYTH: The BUCAHs are using the best analytics to identifyFW&A for self-insured employers.

|

FACT: Self-insured employers are losing between 5 percent and 10percent of their annual spend and have no idea. SOLUTION: Bring ona proven independent watchdog to ensure all claims approved andpaid by the ASOs are legitimate.

|

Massie Meredith, senior VP, business development, 4C HealthSolutions

|

Insurance is a free health care spending pass

One of the most devastating and costly myths impacting consumersof health care is that health insurance is the same thing as healthcare. It's understandably confusing for most folks outside of ourindustry thanks to industry jargon and media misconceptions.

|

The mindset of “I pay a ton for my insurance so I'm going to getmy money's worth” can lead to overuse, unnecessary spend, waste,and compounding complications down the road. Our system would bebetter if all parties involved admitted and understood that thesize and frequency of claims impact what you pay out of pocket forservices as well as what you'll pay for premiums at each renewal!Compounding is great for our investments, but bad for our medicalpremiums.

|

Joey Bickley, health care purchasing consultant, BickleyInsurance, Inc.

|

We're number 1!

The single biggest myth we hear every day: thishospital/doctor/facility is “the best in the country.” They mayhave the biggest marketing budget, but at least 50 percent of thetime, when you look at the objective quality metrics, thatperception proves to be false. It's especially interesting when itis a health care professional who has the (mistaken) perception!The close runner up is “The most expensive place must be the bestplace.” False!

|

Deb Ault, president, Ault International MedicalManagement

|

Costs are too complex to sort out

The biggest myth is that price transparency and pure consumerismisn't possible. Once we get there, we will see the system start tobecome “unbroken.”

|

Sean Glavin, VP, employee benefits, USI Insurance

|

Wellness is a sure-fire investment

Employer Myth: Wellness is a critical part of our strategy toget our employees healthy and lower cost. Future healthcare costs are unknown, so it will always be a gamble.

|

Marcy Heath, health care strategist, InoventiveSolutions

|

There's nothing employers can do

That the procurers of their second biggest line item are tryingto help them lower the amount they spend on said line item. Mostdecision-makers for employer-sponsored health plans have no ideahow bad the deck is stacked against them. The best part is when youshow them other options to align incentives and they still refuseto try something different. I actually blame the employers. It'snot Washington, or the hospitals, insurers or PBM's fault thatemployers continue to get punched in the face and keep coming backfor more.

|

Zachary Jones, senior sales executive, ScriptSourcing,LLC

|

Health insurance protects

The myth is that health insurance protects. Yet, 70 percent ofmedical bankruptcies have health insurance. Over half of employeescan't afford their deductibles and copays, so they don't use theinsurance. Most can't access $1,000, yet the average deductible is$6,500. Employers and their insured employees have been stretchedto the breaking point.

|

Ron Barshop, CEO/founder, Beacon Clinics

|

Read more: 

 

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.