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The companies I know that self-insure hire an actual insurance company to administer and take an administration fee, and just capitalize it themselves. They don

• marcinzm 6y ago
  Yes however they still have access to all medical billing claims as they are the ones paying them. I've worked in this space for three years.
• mlinsey 6y ago
  You're generally correct, but there are exceptions. The payor still has the right to see claims if they want to, and sometimes they will carve out certain services from the insurance plan that's administered for them, usually for cost optimization reasons. In a famous example, Wal-Mart carved out back surgery from their healthcare plan and instead negotiated directly with a few specific hospitals across the country, where all Wal-Mart employees who need back surgery then travel to for care. More common is for big companies to contract with primary care groups to serve their employees directly. (The thinking is that incentives can be better there, since some primary care doctors stay afloat by selling their practices to large hospital chains that they then are encouraged to be aggressive about referring their patients to, raising total costs of care. I think Facebook has this sort of on-site primary care arrangement...this is particularly common in very high cost-of-living cities where it's hard to have what most would think of as a doctor's lifestyle as a primary care physician.
  • benglish11 6y ago
    100% this, in addition Facebook has limited onsite medical care at its facilities that they provide as a perk to employees. Even if this is contracted out there is probably some paper trail as to who used what services.