Simplifying Healthcare

This is arguably the most pressing question HR departments face, particularly during the annual health plan transition prompted by company renewal cycles. Clarity on coverage is vital—without it, employees may inadvertently assume that certain treatments or services are covered when, in fact, they may be subject to limitations, or not covered at all. The fallout from such assumptions can be severe, leaving employees blindsided by substantial bills for treatments or from doctors they presumed were in-network. HR professionals must be equipped to deliver comprehensive details on what the new plans include and exclude. It’s about safeguarding employees from the distress and financial strain of unexpected healthcare costs by ensuring they have a clear, full picture of their benefits landscape.

Insurance carriers regularly update their formularies—the official list of medications they cover—which can result in an unsettling discovery for employees when they go to fill their prescriptions. Employees might find themselves facing the need to switch medications, navigate the complexities of prior authorizations, or challenge a denial of coverage—each scenario demanding clear guidance and support. Alternatively, a long-seen specialist might move out of network, prompting a search for a new provider or the negotiation of continued care under the new plan terms.

Billing errors are surprisingly common, especially in preventive healthcare settings. These are usually a result of human error: providers simply entering the wrong code or neglecting to code a visit as routine preventive care, for example. Improper coding can mean that an employee gets a bill for a visit that should have been covered by insurance. Unchecked billing errors carry a significant financial toll, potentially escalating claim expenses and exerting pressure on a company’s healthcare budget. This is especially detrimental for self-funded organizations, where such inaccuracies directly affect the bottom line. For the workforce, the impact is more than financial. Billing mistakes can lead to considerable stress, complicating their personal and professional lives. The time and effort required to resolve these issues can detract from an employee’s well-being and productivity in the workplace.

If you have employees who are undergoing treatment for chronic illnesses (such as diabetes), or continuing prescriptions (such as birth control), make sure their care team is still in-network under the new plan. If it isn’t, let the employee know they need to contact the new plan administrator immediately to request authorization for ongoing treatment.