August 12, 2025
Louis C. Bernardi, “The Benefits Whisperer”
đź’Ą Certified Healthcare Fiduciary Coach and Health Value Advisor đź’Ą 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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Remember those multiple-choice tests in school?
You’d read the question, glance at the answers, and then — there it was: Option D: Not Enough Information.
It meant you couldn’t answer the question without more facts. It was the honest choice.
When it comes to renewing or redesigning a health plan, plan sponsors are constantly being asked to choose — with Option D removed from the test.
📉 Making Decisions in the Dark
Here’s the problem: Employers and their benefit partners rarely get the whole picture.
The insurance carrier controls the flow of information. They’ll show you:
- A high-level loss run
- Premium totals versus total claims paid
And that’s it.
They won’t show you:
- Itemized claim detail (what was actually purchased and for how much)
- Where the money went (which providers, which facilities, at what prices)
- Hidden profit centers inside their own organization
That means you’re making million-dollar decisions based on summaries — not specifics.
🏦 The Other Books You Never See
Even if you get claims data, you’re still missing Phase Two of the Data Problem:
Your carrier’s parent company may also be…
- A pharmacy benefit manager (PBM)
- A medical provider (owning physician groups, urgent care centers, even hospitals)
Those divisions are making money on your plan — and none of that profit is reported back to you. The only “story” you see is the one they want you to see.
🔍 Why This Matters Most for Experience-Rated & Self-Funded Plans
If you’re experience-rated (typically 100+ covered employees, or 50+ in some states) or self-funded, your actual claims history is your pricing foundation.
If you don’t have the itemized claims, you can’t:
- Identify high-cost, low-value providers
- Negotiate better rates
- Eliminate waste and abuse
- Spot patterns that drive future costs
You’re essentially approving next year’s budget blindfolded.
🧠The PLAN System’s Golden Rule
You can’t manage what you can’t see.
The first step in taking control of your plan is gaining access to all the data:
- Itemized medical and pharmacy claims — not just totals
- Contracts and payment terms — what you’ve agreed to pay
- PBM and provider division profit — so you know where incentives are misaligned
Once you have it, the “game” changes. You’re no longer accepting Option D’s removal. You’re putting it back in — and making decisions with the full story in front of you.
âś… Next Steps
- Main Takeaway: If you don’t have complete, itemized data, you’re making decisions with Option D missing — and the system likes it that way.
- Ask Yourself: Have you ever seen exactly what your plan paid for each medical service and prescription, and how much your carrier’s other divisions profited?
- Imagine This: Your next renewal discussion starts with a full, transparent picture — and the ability to choose the right answer with confidence.
📲 If you’re ready to get Option D back on the table, let’s talk. I’ll show you how to access the missing information and use it to build a high-performance health plan.
Questions? Contact the author at lcbernardi@britepathbenefits.com
Schedule a call at calendly.com/lcbernardi
Visit our website at www.britepathbenefits.com