Take ownership over who accesses your plan’s information.

Do you own your health plan data? That includes the plan pricing, the claims, costs, usage, waste, event risk for your business.

It’s possible you aren’t sure. It’s pretty common not to know the facts. Many employers and plan sponsors aren’t fully aware of how to access their data.  Let alone audit it.  But it is one of the costliest functions.

Every self-insured health plan relies on one critical asset to function responsibly: pricing and claims data. It shows how the plan is used, what it costs, and calls out inefficiencies or overpayments. It can even be evidence in court cases if a sponsor is challenged by employees or regulators.  It’s the foundation for good decision-making and fiduciary oversight.

Now, plan sponsors are the legal owners of that data but can’t actually access it. It’s a bit backwards when businesses are trying to operate well and serve their teams.

A little background on the confusion…

Under the Employee Retirement Income Security Act (ERISA) plan sponsors of self-insured health plans do legally own their pricing and claims data. However, most plans rent their provider networks from large insurance companies or third-party vendors that in return the networks keep a tight leash on it. They consider the pricing details as “proprietary.” It’s worth money to them. So, they refuse to release it.  

A growing wave of lawsuits, including the big one against Johnson & Johnson in 2024, prove the dangers of not knowing what is happening behind the scenes and failing to control healthcare costs. (We did write a bit about the case already that you can check out on our healthcare blog.)

In theory though, the current regulations give self-insured plans the right to access complete claims data. But the reality is that many network owners continue to resist. And yes, while self-insured plans are most common among large companies and still account for only a small percentage of small and mid-sized businesses, the practice is growing. 

Employers can stand up and demand access to data.

• Assert your legal rights: Withholding data forces the plan into potential noncompliance.
• Renegotiate your contracts: Review vendor contracts and insist on language that guarantees access to ALL the pricing and claims data.
• Work with the right partners: Choose consultants that work for the plan not the network.
• Use the data once you have it: Benchmark the wins and identify any waste, empowering your employees with transparent info.

Transparency is the real plan!

When fiduciaries can’t see what they’re paying for, the system stops serving employers and employees alike.

If you don’t own your data, you don’t own your plan. And if you don’t own your plan, you can’t fulfill your duty to your company or your people.

Read more about pricing and claims data access.