When the HIPAA Privacy Rule was enacted in 1996, its intent was to protect personal medical records and health information. This goal has since been weaponized by legacy health insurance carriers who withhold data from fully-insured plan sponsors to obscure their justification for higher premiums.
A recent article explains how smaller employers “only receive meager large-claims data at the end of the year. You will not get month-to-month claims versus premium information. The stated reason: carriers are concerned that if they give you too much specific detail about your employees’ health and claim activity, you may be able to discern who has what condition. This, the logic goes, violates HIPAA. The smaller your population, the greater this risk. … This argument is absurd, but it has been the reality in the industry for twenty years.”
There is another, perhaps more insidious, reason for not sharing claims data: to keep employers from escaping the prison of the legacy carriers’ fully-insured health plan. Claims data are the “receipts” for an employer’s plan expenditures with healthcare providers. Without this vital information, fully-insured employers cannot get the stop-loss insurance that enables self-insurance and the cost control and plan design freedom that it brings.
Privacy and transparency are not mutually exclusive. Both can be attained with a modern, self-funded health plan that eliminates the conflicts of interest inherent in fully-insured legacy plans.
By choosing a health plan administrator like Vitori Health, employers can experience freedom of choice, total transparency, and unfettered access to claims data supported by a proven cost and risk suppression platform. Employees will receive better benefits at a lower cost and a remarkable member experience.