While employers want to provide the best benefits they possibly can, certain services and specialties continue to strain budgets. Unprecedented behavioral health needs are hitting an already fragmented, marginalized care infrastructure.² Leaders across all sectors will need to make difficult compromises to treat and pay for behavioral health as they do for other complex, chronic conditions.²

A greater scrutiny over health care affordability

At least 64% of large employers indicate that in 2024, they plan to make benefit enhancements to their health and well-being offerings to attract and retain employees and better meet their needs.⁵ Increasingly, employers are looking for ways to offer richer health benefits — at minimal additional cost. Responsible employers will aim to better understand their health care costs, coordinate their finance and benefits departments and scrutinize benefits partners more closely. 

Meanwhile, the average costs for U.S. employers that pay for their employees' health care could increase 8.5% to more than $15,000 per employee in 2024.⁶

To stay competitive and retain employees, more and more employers are looking for ways to enhance health benefits — without shifting cost to employees. Some employers are willing to absorb costs to not increase the financial burden to employees. Strategic employers will aim to better understand their health care costs, coordinate their finance and benefits departments and scrutinize benefits partners more closely.

While health care costs continue to rise, several market factors are at play. The converging financial pressures of elevated input costs, a volatile macroeconomic climate and the delayed impact of inflation on health care prices are exposing the entire industry to even greater scrutiny over affordability.³ These rising costs will need to be covered somewhere and out-of-network cost management is one area to focus on.

Going out-of-network is not going away

Despite efforts on the part of health insurers and employers, employees continue to use out-of-network providers. In some cases, employees don’t go out-of-network willingly, like in the case of a medical emergency. In other instances, the decision to go out-of-network is driven by the desire to use a provider the employee trusts and has an established relationship with.

While the effort required to rein in out-of-network use will continue, the reality is that out-of-network will remain part of the benefits puzzle and therefore part of the cost problem. This means viable, proven solutions for managing out-of-network are vital. That’s where Naviguard® comes in.

What these times demand 

Naviguard is an additional health plan benefit, designed to lower out-of-network costs while giving employees someone to turn to when surprise balance medical bills arrive. In short, we offer robust advocacy for employees via dedicated one-to-one relationships, help resolving unexpected out-of-network balance medical bills by negotiating directly with providers and deliver end-to-end issue resolution. How successful is Naviguard? (Thank you for asking.) Since January 2021, we reduced out-of-network balance bills an average of $2,000 per case.⁴ Our total employer savings to date is more than $8.0 billion.⁴

What’s more, Naviguard has driven an average savings of 72% on out-of-network billed charges for disputed and all other paid claims, outpacing the level of savings achieved by many competitive programs such as shared savings and other third-party vendors.³

Clearly, these times and the days ahead demand that employers have a resource with a deep understanding of health care costs and broad experience providing out-of-network solutions. With Naviguard in their corner, employees may experience less stress from the financial burden of out-of-network balance bills and improved well-being that comes from having less stress. Employers, meanwhile, have happier employees, better retention and can devote less administrative time helping employees understand their health plan and resolve out-of-network balance bills.

Naviguard offers employers a meaningful benefit enhancement that can help in their efforts to attract and retain employees. Not surprisingly, I recommend Naviguard. We have a best-in-class solution to managing out-of-network costs.

Brad Anderson is the CEO of Naviguard and has held numerous senior-level positions in the health insurance industry.