We all have that little piece of plastic in our wallets. It’s convenient, right? But imagine if every time you swiped your card, your $4 coffee suddenly cost $60—except you didn’t see the charge breakdown. You only found out months later, buried in a statement, and even then, no one could explain exactly where the extra money went.
You probably wouldn’t keep using that credit card. You’d demand transparency, switch banks, or find a way to pay without all the hidden fees and inflated prices.
So why are we okay with letting our health plans operate the same way? (I wrote a blog in 2016 talking about the Healthcare Stockholm Syndrome of plan sponsors)
Every employer-sponsored health plan is riddled with hidden fees from service providers—PBMs, insurers, and third-party administrators—that you don’t see but you absolutely pay for. These fees drive up the cost of care, impact your employees’ premiums and out-of-pocket expenses, and often go straight into the pockets of vendors who claim to be your partners.
And let’s talk about gag clauses. You know, those little contractual landmines that prevent you from seeing what’s actually happening with your plan’s money? PBMs and carriers have been swearing for years that there’s no restriction on your data, but let me ask you…
Have you actually seen your rebate dollars, claims detail, or network contract terms?
Can you compare what you’re paying to publicly available, posted hospital prices or benchmark your costs against what percentage of Medicare rates you’re paying?
Better yet—when your RFP and renewal negotiations roll around every year, do you have enough detail to actually negotiate with other markets? Or are you stuck taking whatever your incumbent vendor offers because you have no leverage?
If not, you may be in a prohibited transaction.
The Department of Labor made it crystal clear in FAQ 69 (January 2025)—if your plan has contracts with gag clauses that prevent you from accessing your own data, you are in violation of federal law. And guess what? The PBMs and carriers aren’t on the hook for it—you are. Source
I broke down some of these hidden costs and how they impact your plan on Relentless Health Value, Episode 433 with Stacey Richter.
But here’s the bottom line:
✅ If you don’t know your data, you don’t control your plan.
✅ If you don’t control your plan, you’re overpaying—by a lot.
✅ And if you’re overpaying, someone else is making money off of you.
So ask yourself: Would you keep swiping that credit card if you knew you were getting scammed on every single transaction?
It’s time to start treating your health plan the same way.
#WeFixYourHealthcare #Transparency #PBMFees #FiduciaryDuty #KnowYourData
View the original LinkedIn post here.
