“We then compared that uninsured person to us – what we’re paying – and in many cases what we found is we’re paying more than an uninsured person.”
Controller says Lehigh County could save another $4M on health care costs
Oct 26, 2022
ALLENTOWN, Pa. – A new audit from Lehigh County Controller Mark Pinsley says the county can save itself – and taxpayers – another $4 million on health care costs.
“So the first way – and probably the most important thing – that we looked at was how much does it cost for an uninsured person for any procedure?” PInsley said. “We then compared that uninsured person to us – what we’re paying – and in many cases what we found is we’re paying more than an uninsured person.”
Procedure prices are negotiated between hospitals and insurers.
Pinsley found the county’s insurer is generally paying more.
“Our expectation would be that we would not pay any more than an uninsured person,” Pinsley said. “That would be the starting point and in some cases we don’t, and in some cases we do.”
Hospitals are now required under federal law to have transparent pricing, but Pinsley says it’s still difficult to obtain and decipher.
He adds that isn’t the only reason the county is paying too much: “We have a 35% fee that we’re charged by Highmark to investigate their own payments and see if they did anything wrong. So, for example, last year we paid about $350,000 in fees to Highmark for mistakes that either they made, or the hospital made, or someone else made in billing.”
We spoke to County Executive Phil Armstrong, who pointed out that the county is already saving $3 million this year with a new prescription plan.
Pinsley says, moving forward, the county needs to compare bids from providers with Medicare pricing.
“It doesn’t necessarily have to be the lowest price,” he said. “It has to be the lowest price with the highest quality service.”