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> They definitely do if they’re self insured. Self-insured doesn't mean they manage claims themselves. For most companies, managing claims would be cost-prohib

> They definitely do if they’re self insured. Self-insured doesn't mean they manage claims themselves. For most companies, managing claims would be cost-prohibitive and an absurdly wasteful use of resources.

undefined3840 7y ago
Most companies use a Third Party Administrator (TPA) for the actual back office claims management. That doesn’t mean people in HR and Finance don’t have visibility into claims data.
- chimeracoder 7y ago
  > Most companies use a Third Party Administrator (TPA) for the actual back office claims management. Yes > That doesn’t mean people in HR and Finance don’t have visibility into claims data. I mean, this is technically a true statement - "A does not necessarily imply not-B" - but kind of irrelevant, because as it turns out, HR and finance generally do not have visibility into individual-level claims data (as opposed to aggregate data, which is necessary for underwriting).
  - undefined3840 7y ago
    I mean key word “generally”? I’m not suggesting that there’s a team of employees watching you every time you pick up a prescription, but of course they could access an individual claim if there was a legitimate reason to. Not sure why it’s so unbelievable to think that an insurer would be legally barred from doing so if they are literally taking on the risk themselves, even if it is to audit the TPA to make sure they aren’t stealing from them. If you are an extremely ill employee and you’re using a lot of healthcare your employer will know without you needing to inform them.
  - jasode 7y ago
    >, HR and finance generally do not have visibility into individual-level claims data I'm not debating with you but somehow, Tim Armstrong (then CEO of AOL) found out about healthcare claims for one of his employees.[1] The story isn't clear on whether the granularity of the claims data would reveal to Tim who the particular employee was. (Even if Tim didn't know the exact employee, I'm sure he could ask a few questions and/or look at employees' sick day records to figure out which employee it was. If the company pays $1 million in a health claim, that's not necessarily going to stay a secret.) [1] https://slate.com/human-interest/2014/02/tim-armstrong-blames-distressed-babies-for-aol-benefit-cuts-hes-talking-about-my-daughter.html https://slate.com/human-interest/2014/02/tim-armstrong-blame...

undefined3840 7y ago

Most companies use a Third Party Administrator (TPA) for the actual back office claims management. That doesn’t mean people in HR and Finance don’t have visibility into claims data.

chimeracoder 7y ago
> Most companies use a Third Party Administrator (TPA) for the actual back office claims management. Yes > That doesn’t mean people in HR and Finance don’t have visibility into claims data. I mean, this is technically a true statement - "A does not necessarily imply not-B" - but kind of irrelevant, because as it turns out, HR and finance generally do not have visibility into individual-level claims data (as opposed to aggregate data, which is necessary for underwriting).
- undefined3840 7y ago
  I mean key word “generally”? I’m not suggesting that there’s a team of employees watching you every time you pick up a prescription, but of course they could access an individual claim if there was a legitimate reason to. Not sure why it’s so unbelievable to think that an insurer would be legally barred from doing so if they are literally taking on the risk themselves, even if it is to audit the TPA to make sure they aren’t stealing from them. If you are an extremely ill employee and you’re using a lot of healthcare your employer will know without you needing to inform them.
- jasode 7y ago
  >, HR and finance generally do not have visibility into individual-level claims data I'm not debating with you but somehow, Tim Armstrong (then CEO of AOL) found out about healthcare claims for one of his employees.[1] The story isn't clear on whether the granularity of the claims data would reveal to Tim who the particular employee was. (Even if Tim didn't know the exact employee, I'm sure he could ask a few questions and/or look at employees' sick day records to figure out which employee it was. If the company pays $1 million in a health claim, that's not necessarily going to stay a secret.) [1] https://slate.com/human-interest/2014/02/tim-armstrong-blames-distressed-babies-for-aol-benefit-cuts-hes-talking-about-my-daughter.html https://slate.com/human-interest/2014/02/tim-armstrong-blame...