September 25, 2025
Louis C. Bernardi, “The Benefits Whisperer”
💥 Certified Healthcare Fiduciary Coach and Health Value Advisor 💥 I work with Business Leaders of mid-sized. Did you know that optimizing your healthcare plan can contribute directly to your company’s survival and growth? ✨ When we compare the benefits of healthcare savings to findings from a recent college essay, “Ten Reasons Why Companies Keep Failing,” the connections are clear. Let’s explore how healthcare optimization addresses these pitfalls:
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In any negotiation, knowledge is power. You study your counterpart’s habits, tactics, and incentives. You look for their strengths and weaknesses. The same rule applies to health insurance — make no mistake, it is a negotiable business expense.
But here’s the catch: most plan sponsors go into renewal negotiations blind. They don’t see the intricate details of their own claims. Meanwhile, insurers hold all the cards, showing you only what they want you to see.
The Insurer Isn’t Just Your Insurer
Take UnitedHealth Group (UHG) as an example:
- Nearly 2,700 affiliated companies worldwide.
- The largest employer of U.S. physicians.
- A 21% share of the PBM market via OptumRx.
- A business model that profits not only from premiums but also from owning the providers, pharmacies, and drug benefit managers that your claims are paid to.
What looks like a loss on your “insurance bubble” may in fact be a hidden win for the insurer, with dollars captured again through rebates, spread pricing, and provider referrals — practices under active DOJ investigation.
Why Data Changes the Game
For years, plan sponsors had no way to push back. The insurer’s version of the data — loss runs and actuarial projections — was the only story on the table.
Now, that’s changing. With modern analytics and AI-driven tools, plan sponsors can see what was once invisible:
- Top drugs and their real costs
- Prevalent medical conditions driving claims
- High-cost claimants and their treatment pathways
- Anticipated claims spend based on emerging trends
This isn’t just data — it’s leverage. It gives you actionable insights that can counter an underwriter’s assumptions and projections. When you show up with evidence, not just opinions, the negotiation shifts. You’re no longer reacting to the insurer’s numbers — you’re presenting your own.
What You Can Do
You can’t stop insurers from expanding their empires, but you can stop being a passive buyer.
- Know the machine: understand that your insurer profits in multiple ways, not just on premiums.
- Bring your own data: actionable insights into your plan’s spend, conditions, and risk drivers give you the leverage to push back.
- Reset expectations: this isn’t a fixed cost — it’s a negotiable line item, and the balance of power is shifting.
The Takeaway
Negotiations always favor the side that comes prepared. In health insurance, preparation means understanding not only your insurer’s incentives, but also your own claims data.
With today’s technology, plan sponsors can finally see into the machine — and use that knowledge to negotiate from a position of strength.
Stop treating health insurance as a black box. Start treating it as the negotiable business investment it really is — backed by data, powered by insights, and leveraged for the good of your company and your people.
Questions? Contact the author at lcbernardi@britepathbenefits.com
Schedule a call at calendly.com/lcbernardi
Visit our website at www.britepathbenefits.com