Inappropriate Behavior by Third Party Payers is Detrimental to Employer-Sponsored Health Plans

For Immediate Release

Washington, DC – The ERISA Industry Committee (ERIC) today submitted comments to the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) on the role of third party premium payers, and how the inappropriate steerage of employer-sponsored health insurance beneficiaries to out-of-network providers threatens to increase costs for working families.

As the only national association that advocates for large employers on health policies at the federal, state and local levels, ERIC seeks to enhance the ability of its members to provide high-quality health care benefits to millions of active employees, retired employees, and families. When third parties intervene in steering an individual to a specific insurance or provider option, what may appear to be innocent assistance could in fact be an effort to change that individual’s coverage and caregiving in a way that benefits the third party or others, but may be worse for the patient.

“ERIC appreciates the Department of Health and Human Services investigating third parties deceptively leading individuals into insurance plans that maximize provider reimbursement rather than patient care, as it is an important issue to the entire health care sector. We strongly urge HHS to also consider how employer-sponsored health insurance plans are adversely affected by similar inappropriate behavior,” said James Gelfand, senior vice president of health policy, ERIC. “And it’s not just between plans – it’s also between providers and medical facilities. Preserving the ability of employer plans to craft and utilize provider networks is crucial, and arrangements by which providers can use financial incentives to steer plan beneficiaries to out-of-network facilities severely undermine a plan’s ability to use a network and control costs.”

To read ERIC’s comments to HHS, click here.

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All media inquiries to The ERISA Industry Committee should be directed to:

Kelly Broadway, 202.627.1918, kbroadway@eric.org

About the ERISA Industry Committee
ERIC helps America’s largest employers stay ahead of employee benefit policy. ERIC member companies are leaders in every sector of the economy, and we represent them in their capacity as sponsors of employee benefit plans for their own workforce. Only ERIC provides the combination of intel, expertise, collaboration, and lobbying that exclusively serves the interests of large employers who provide health, retirement, and compensation benefits to their nationwide workforce.