For Self-Insured Employers (500+)

Healthcare Price Intelligence for Self-Insured Employers

Independent analysis. Measurable savings. A partner who works for your plan, not your carrier.

Confidential · April 2026
The Blind Spot

Your Plan Costs Are Unaudited.
That Is Not an Accident.

Self-insured employers cover 65% of insured American workers. They bear the full financial risk for their employees’ healthcare — yet they make million-dollar spending decisions with almost no visibility into whether the prices they’re paying are reasonable or whether claims are being processed correctly.

The party administering your plan earns fees on the spread between billed charges and contracted rates. They have no incentive to tell you the contracted rate itself is above market. This isn’t an allegation — it’s the business model, and it’s now the subject of active DOJ antitrust scrutiny.

$150,000 to $450,000 in recoverable overpayments at a typical 1,000-employee plan.

What We Do

Price Intelligence

We show you whether your contracted rates are competitive — something your TPA has no incentive to tell you. We audit the contract, not just the claims. Our benchmark is derived exclusively from publicly available federal pricing data. No carrier relationships. No conflict of interest.

Claims Analysis

We review claims data to find billing errors, overcharges, and adjudication mistakes — on both sides of the transaction. Duplicate payments. Upcoded procedures. Out-of-network billing errors. Most employers have no way to independently verify whether their claims are being processed correctly.

Advisory & Strategy

We translate findings into action. Negotiation strategies for provider disputes. Plan design recommendations backed by utilization analysis. Fiduciary compliance assessments that give CFOs documented evidence their plan is being managed prudently — under ERISA Section 404 and the Consolidated Appropriations Act.

What We Find — Representative Engagement (Anonymized)

At a 91-employee level-funded employer, a single utilization report revealed $41,000 to $99,000 in recovery opportunities — the smallest finding alone covers two years of fees:

  • Lab cost gap — hospital lab at $113/test vs. $9.57 at preferred alternatives (this finding alone covers the annual engagement fee)
  • Cancer treatment with home infusion billed at nearly 3× the plan norm (the material recovery)
  • Pharmacy utilization with significant unmanaged cost exposure
$150K–$450K recoverable per year.
At your scale, the opportunity is proportionally larger. A 1,000-employee plan typically carries $150,000 to $450,000 in recoverable overpayments per year.
Page 1 of 2
$800B
wasted annually on U.S.
healthcare admin overhead
65%
of insured workers covered
by self-funded employer plans
~100M
covered lives in the
self-insured employer market
How We Engage
Low monthly per-employee fee
Continuous plan monitoring, claims review, and advisory support.
Shared savings on verified recoveries
We earn a share only when money is actually returned to the plan.
Fully aligned incentives
We do better only when you save more.
Fast time-to-value
First utilization analysis within one week of data receipt. No data infrastructure required to get started.
Your Rights Under Federal Law

The Consolidated Appropriations Act of 2021 gave self-insured plan sponsors a statutory right to claims data from their TPA. Most employers don’t know this right exists — and many TPAs have been slow to comply.

We help you exercise that right and use the data to verify your plan costs are reasonable. This conflict of interest is now the subject of active DOJ antitrust scrutiny (AMA v. MultiPlan/Claritev).

ERISA Section 404 requires plan fiduciaries to act with the care and diligence of a prudent person. Our quarterly compliance reports provide the documented evidence you need to demonstrate ongoing monitoring — not just trust in the status quo.

The Regulatory Shift

ERISA fiduciary litigation hit a record pace in 2025, with 22% of class actions naming health plan sponsors. The standard of care is no longer “we trusted our TPA.” Opposing counsel asks what you documented, not what you intended.

Employers who audit independently stay ahead of recovery opportunities and build the documented compliance trail that protects them. We provide that trail as a matter of course.

The question isn’t whether claims review is worth the ROI. The question is: what’s your exposure if you don’t do it? One late-stage colorectal cancer diagnosis costs $150K–$400K — that’s 27 to 73 times the annual engagement fee. Our benchmark methodology is documented in plain language: which peers, which metro, how current.

Two invoices. Nothing else.

Low monthly per-employee fee + shared savings on verified recoveries. We earn a share only when money is actually returned to the plan. If we find nothing, you pay nothing.

Fully Independent
HIPAA Compliant
BAA with Supabase/AWS • Data De-identified
SOC 2 Aligned
medicalbills.com
Healthcare Price Intelligence · HIPAA Compliant · Deep Texas Coverage, Expanding Nationally
Schedule a Consultation
Kit Nowlin, CRO · kit@medicalbills.com