The Cost of Compliance

The many requirements of the Consolidated Appropriations Act of 2021 (CAA) have forced plan sponsors and the brokers guiding them to find compliance solutions. With tight deadlines and the threat of large penalties, this burden fell to independent third-party administrators who were forced to find off-the-shelf solutions from opportunistic tech companies. These vendors wisely solved a need created by new regulations by offering tools designed to help plans comply. While necessary to stay compliant, checking the box on these requirements has come at a cost for clients offering progressive plans not utilizing a traditional network. The cost is twofold. First, TPAs are passing along the cost of the tools to plan sponsors directly as a line item cost as part of their services agreement. Secondly, these solutions are not built for nor aligned with network-free solutions, creating a level of unintended friction. At ClaimDOC, we made the choice to invest in the necessary technology to offer our clients compliance solutions that create a better member experience without additional cost.

The savvy entrepreneurs who have entered this data/tech space in today’s environment must create a solution that appeals to a wide variety of plans while representing compliance to the clients. The problem with this reasonable approach is that these tools cannot address the nuances of our DirectAccess™ Plan and, as a result, could run the risk of actually confusing and disrupting the member experience. Providing pure pricing information ignores the most important thing all network replacement programs should be focused on: access. Cash price solutions that may be alternatives aimed at driving consumerism rely purely on transparency data that research has shown is incomplete and flawed.

Soon after the CAA was released, ClaimDOC recognized the need to create a solution that was specifically designed for our program. Over the last three years, we have invested and reinvested in our business to meet the technology demands of the CAA and to enhance the member experience. As a result, we have created a pricing tool that not only provides patients with the cost information the CAA requires, but also educates patients about access with either the providers that are already working with our program (existing access) or new providers through our outreach program, Pave the Way®. While we will always preach our success in prioritizing person-to-person interaction for the best experience, we will continue to develop and respond to market demands and requirements.

We continue to focus on the member experience while still achieving savings in our proactive approach of developing relationships with members while giving them the technology they need to navigate the plan. Surprising to some, but not to those who have interacted with our amazing Member Advocates, the vast majority of members like speaking to a helpful voice. The market demand is often out of touch with the everyday member, however, our business strives to satisfy both. Without the market being satisfied, you won’t drive new business, but without the members being satisfied, you won’t retain business.

The first two phases of ClaimDOC’s response to the CAA included the development of the internal infrastructure to generate plan-specific machine-readable files and the creation of a program and process to facilitate all aspects of the No Surprises Act. Adding the pricing tool combined with provider access is the third phase of our technology advancements in response to the CAA. We offer these additional pricing tools designed to meet the CAA’s requirements for our clients because we know that adding layers of new vendors and various products to a plan only adds confusion and distraction for members. By developing a comprehensive program, ClaimDOC offers a best-in-the-market solution without any additional cost to clients.

Brokers and clients need to ask questions. The non-traditional product space is full of brokers and vendors scratching each other’s backs while the plan sponsor pays the price. While most employers have only felt the negative consequences of the increased compliance burdens of the CAA, including increased fixed costs and no reduction to the overall cost of healthcare, employers utilizing ClaimDOC have benefited from ClaimDOC’s ingenuity and commitment to affordable healthcare. Our clients have access to tools that are both compliant and create a better member experience for their employees at no additional cost. Others may nickel and dime their clients with new shiny objects, which some might say is just good business. At ClaimDOC, we stay true to being a valued partner, not looking at every market whim or compliance need as a revenue generator. Another reason it’s great to be privately owned.