How can an image be worth a thousand words when it leaves you speechless? How can anyone justify why trillions of dollars in doctor services, drugs, and medical care expenditures exceed the Consumer Price Index, with hospital services exceeding at a whopping 347%?

What if food, housing, and utility costs increased at such rates over the past 30 years? It’s a nightmare that’s unthinkable… and unsustainable.

A report issued by The Commonwealth Fund comparing U.S. healthcare to other high income countries states that the “United States ranks last overall, despite spending far more of its gross domestic product on health care.” The U.S. also ranks last on access to care, administrative efficiency, equity, and health care outcomes.

Wholesale changes to the healthcare industry are needed to slow this outrageous cost trend and improve the value of care delivered. Instead of waiting, forward-thinking employers are embracing high-performance health plans that adhere to ethical billing practices, strict cost controls, and fair market payments. Doing anything less just perpetuates the madness.

A woman in California received treatment for a broken foot at a reputable orthopedic facility. She was happy with their service until she looked at her bill: $809 for a plastic walking boot that costs about $80 on Amazon. She assumed it was a typo but after contacting the facility, she was shocked to learn the charge was correct.

To her credit, she raised her concerns about the astronomical 1,000% markup to senior administrators. Sure enough, there was an error: she should only have been charged $639. Really?!!

It’s no secret that the US health care system routinely gouges employers and plan members with inflated and nonsensical charges. Americans pay roughly double what those in other developed countries pay for care. But this situation demonstrates the degree to which outrageous greed has driven increases in deductibles, co-insurance payments, and ultimately, out-of-pocket costs for patients everywhere.

Since the industry won’t police itself, employers must take the lead in demanding transparent billing practices and fair market reimbursement. Employee health plans with clean contracting and pre-payment cost controls can help mitigate these abusive practices and protect employees from unexpected and outrageous charges. Employers need a plan that ensures situations like this simply cannot continue to happen.

Imagine you’ve been hired as the CFO of a well-known regional health system. You’re told during your interview that they’re looking for someone who can make difficult changes to address systemwide financial and accounting issues.

So, you dig into the known issues and find even more problems with inaccurate billing practices. You raise the flag about super-high error rates and the likelihood of repaying more than $5 million to correct the systemic errors. And then, BAM! You’re fired!

As crazy as this seems, it demonstrates how hard it is to change entrenched (and illegal) industry-wide practices that have thus far worked to your advantage. And give money back? Never! But there are things plan sponsors can do to start changing bad behavior.

The Value of Pre-Payment Integrity Controls

Employee health plans can directly combat egregious billing practices begin by knowing and validating care costs before paying any claim. They can eliminate price-blind buying and use transparent algorithms to establish payment rates that are fair for providers, employers, and plan members. And then they can scrutinize every claim to ensure accurate billing and reimbursement.

It’s time to change the buyer-seller relationship. We can’t rely on the industry to police itself, so buyers must align with a conflict-free health plan administrator who will fight on their behalf for transparency and payment integrity and take decisive steps to ensure they aren’t victimized by unfair billing practices.