Published on: July 8, 2025 at 3:53 pm
As dissatisfaction with the U.S. healthcare system grows, the responsibility to ensure that workers are getting services falls to employers by default.
Ensuring that healthcare insurers and third-party administrators (TPAs) are delivering what they’ve promised and aren’t denying doctor-recommended procedures shouldn’t require hiring anyone new; it should be a core element of the responsibilities of the human resources (HR) department, according to Academy of Management Scholar Jeffrey Pfeffer of Stanford University. He said HR personnel should be able to fulfill this important duty without it becoming an onerous task.
“I don’t actually think that’s too much to ask, doing a survey of your employees and collecting data from your benefits administrator to find out what percentage of claims are denied, how much coverage costs, how much prior authorization there is, all this stuff,” Pfeffer said. “I don’t think this requires advanced analytical skills.
“This requires a relatively simple employee survey and then holding people at health insurers and TPAs accountable,” he said.
As an example of what’s possible, Pfeffer cited the example of Marilyn Bartlett, a CPA and former insurance executive who negotiated with health insurers, TPAs, and hospitals on behalf of Montana’s employee healthcare plan, proving that bargaining to reduce healthcare prices can work well.
“This is a very smart woman who had worked for years for a health-benefits company, but you do not need enormous amounts of expertise to hold benefits administrators accountable,” Pfeffer said. “You would just need to define what some standards are: How much time should people be waiting on hold? What percentage of claims have been denied? How many claims should be denied? How much prior authorization should we do? Are we following the recommendations of the American Medical Association?
“Ask yourself, ‘Are we doing this benefits administration oversight in any in an efficient and effective manner, as you would measure anything else?’ and the answer to that is, in almost every case, ‘No,’” he said. “Specialization for this role may be necessary, but I don’t actually think so—this is pretty straightforward.”
