An inner demon has been bothering me for the past 15 months….the demon screams to be released
By Molly Mulebriar
This morning I received a first draft of an article from an industry thought leader to be published soon. A sentence within the piece caught my attention – “Your day of reckoning is fast upon you.”
The article addresses the lackadaisical manner in which most American businesses monitor their second or third largest company expenditures, health care, and the employer’s fiduciary duty to protect plan assets by spending prudently and in the best interests of plan members.
This rekindled an inner demon that has been bothering me for the past 15 months…..the demon screams to be released.
My angst stems from a Texas school district who knows and understands they are over paying for health care but has refused, so far, to do anything about it despite repeated efforts to lead them into the world of common sense and typical American business practices.
You can lead a horse to water but you can’t make them drink ……
It is crystal clear that plan members are overpaying for health care.
For the past 15 months the plan’s third party administrator has adjudicated claims through the plan’s PPO network while at the same time bench marking against Medicare reimbursement levels. The result shows the plan is paying 338% of Medicare in the aggregate for facility claims.
Several school districts nearby are paying the same medical caregivers 120% of Medicare, or about half as much. Given evidence others are paying much less for health care, this school district has consciously decided continue to over pay for health care.
Why?
The answer is fear of the unknown. Fear of balance billing. Fear of provider boycott of plan participants. Fear of lawsuits. Fear of push back from plan members. Yet what they fail to understand is that none of these fears are founded in any kind of rational thinking or historical context. Instead it’s all about emotion.
The question that should concern all plan sponsors is “What will happen when plan members finally realize their employer has failed to act to protect plan assets, knowing plan members are overpaying for health care and allowing them to continue to do so?
Will plan participants seek legal recourse? Will that Day of Reckoning be sooner or later? With the number of lawsuits filed in the past 24 months nationwide against plan sponsors for breach of fiduciary responsibilities, we suspect an army of lawyers will join others seeking lucrative opportunities that could rival the tobacco settlements of years past.
The demon has been released……………………now what?
Editor’s Note: Molly Mulebriar is an investigative reporterette from Waring, Texas. She can be contacted at www.mollymulebriar.org
