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This is in response to A World Without Open Enrollment? .

Tuesday, October 19, 2010
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What has always been called the 'third-party payer' system of healthcare is really more than that.  The employer (a fourth party) chooses a health plan usually on cost.  The employee in many cases has no option.  Therefore the insurance company pleases their customer by offering lower rates, but then maybe has lousy service to the employee/patient and the medical provider.  Add in a fifth party like a union, then an EAP, then perhaps the dependent or spouse, or ex-spouse and we further complicate the transaction. 

So my union negotiates benefits paid for by my employer provided by an insurer who I didn't pick to give healthcare by a provider to my child who lives with my ex-wife who isn't happy with the medical decisions made by the pharmacy benefit manager chosen by the insurer.  Am I to eight or nine parties now?  Don't forget about the Third Party Administrator who can't get the billing correct!

I don't know if the demise of employer based health insurance is good or not, but I am all for trying a system where I decide the insurance I want from whoever gives me the best service, price and value.  As the author suggests, like defined benefit plans, I think employers will be inclined to fund the benefit but not control the rest of the aspects, like a self-directed 401k.  Once the first major corporations go that way, the rest will follow.

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Don Stumpp

Manager of Payer Contracting

American Health Network of Indiana, LLC

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