Reconcile
Premium invoices, enrollment tiers, payroll contributions, credits and applicable refunds.
Fully insured employers
You deserve a better answer than
"you cannot get any data."
A blanket funding-status refusal is the beginning of an inquiry, not its conclusion.
What the law supports
Ask for the specific records, not a slogan.
CAA gag-clause protections extend to fully insured and self-insured group health plans, with applicable exceptions. They concern specified cost, quality and de-identified claims information and appropriate business-associate sharing. Agency guidance also addresses downstream restrictions and unreasonable access limits.
The legal basis, plan type, information requested, contract and privacy conditions still matter. We do not promise that every request will succeed or that an employer owns every record.
The fully insured examination
Useful evidence goes beyond a raw claims file.
Trace
Broker and consultant compensation, service agreements, carrier confirmations and vendor overlap.
Challenge and document
Renewal assumptions, information restrictions and unsupported refusals, with a lawful escalation path.
What we will not do
An insurer's pooled margin is not your claims account.
We do not treat the difference between your premium and available claims as recoverable waste. Nor do we assume that a medical-loss-ratio percentage proves your company's particular refund entitlement. The analysis respects the distinction between insured risk transfer and a self-funded program.
Where records support a conclusion, we say so. Where they do not, we say that too.
An executive conversation. Not a broker pitch.
What would better evidence change?
Start with your headcount, funding type and next plan decision. No patient data needed.