3 Factors That Drive Up The Cost Of Your Employee Benefit Plan


employee benefit planYou don’t get an employee benefit plan without the intention of actually using it but sometimes certain factors, such as unreasonable billing, can result in denied claims or partial reimbursement.

It’s important for you to know what unknown factors are affecting your employee benefit plan so you can properly educate your employees on how to effectively use it. Excessive claims can result in increased premiums at renewal time so a few simple best practices can save you money when it comes to that time of year.

1. Pharmacy Dispensing Fees

You can include the dispensing fees in your benefit plan so when you get your drug card all you have to do is show it at the pharmacy to have the insurance company pay directly.  You can go to certain pharmacies and the dispensing fee is only a few dollars but other locations charge nearly $15 per medication – a number that adds up quickly with chronic illnesses that require monthly fill-ups.

TIP: Educating your employees about locations that offer discounted dispensing fees can make a big difference upon renewal time because you will have cost the insurance company less money.employee benefit plan

2. Unreasonable Billing For Medications

Similar to the large fluctuation in cost with dispensing fees, medications actually also range in costs between pharmacies. In some cases the cost difference can be as high as $1 per pill – a significant amount for the same product.

Insurance companies may not reimburse expenses that are not “reasonable & customary” so it’s worth knowing which places offer the best prices. A great new tool for BC residents called Pharmacy Compass does exactly that and can be accessed here.

pharmacy compass

3. Excessive Charges For Massage

This is one area of abuse that many employees feel they can easily get away with and tends to be an issue. If the insurance company receives a bill for two hours worth of massages at a health spa, they may want to see a doctor recommendation to ensure it is medically necessary.

If charges are not considered “reasonable & customary”, they could very well be rejected for reimbursement. Massages are great but they aren’t always medically necessary and when they are, they should be within reason. It will be tough to get that spa day bill picked up by the insurance company, regardless of any employee benefit plan.employee benefit plan

In Conclusion

You don’t want to be regularly making claims above the average cost of rates for those services in your area. Be aware of practitioners that may try to take advantage of your benefits coverage and overcharge because they think you won’t notice the difference anyways. Most people tend to be ethical but others…not so much.

It might seem like your employee benefit plan is like free money but when renewal time comes around, you might see those excessive charges come back to bite you.

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