Relentless Health Value Take Two: EP433: The Mystery of the Weekly Claims Wire, With Justin Leader
Jun 5, 2025
In a thought-provoking discussion, Justin Leader, CEO of BenefitsDNA, dives into the murky waters of third-party administrators (TPAs) and their impact on healthcare costs. He sheds light on hidden fees buried within weekly claims wires, including shared savings and pay and chase fees. Justin emphasizes the pressing need for transparency and fiduciary responsibility among self-funded employers. With references to ongoing legal cases and insights from Health Affairs, he urges listeners to scrutinize TPA contracts for a clearer understanding of their true costs.
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Hidden Fees Inflate Claims Wires
- Weekly claims wires often hide fees not detailed in contracts, which may not be transparent to plan sponsors.
- These hidden charges can include shared savings, prior authorization, prepayment integrity, and adjudication fees that increase costs invisibly.
Demand Detailed Claims Registers
- Plan sponsors should demand detailed claims registers and approve weekly claim payments carefully.
- Scrutinize the varying invoice details to better understand what is actually being paid each week.
Self-Funding Lacks Transparency
- Moving to self-funding doesn't guarantee transparent or accessible claims data.
- Plan sponsors must aggressively seek clarity on fees and services behind weekly charges.