How Self-Funded Employers Can Help Employees Avoid Surprise Medical Bills

Make Staying In-Network the Easiest Choice

Employees already have a lot on their plates. Expecting them to research network status for every provider creates friction, and friction leads to inaction. Employers can simplify the process by making in-network care the path of least resistance. 

Educate employees on the benefits of staying in-network, including: 

• Lower out-of-pocket costs due to negotiated rates
• Lower or no copays at Preferred-Value Providers
• Predictable expenses with fewer surprises
• Smoother billing experiences

Employers can: 

• Post direct links to your network directory everywhere you have your benefit information. For example, The Alliance’s Find a Doctor tool allows employees to search for in-network providers.
• Educate employees on where to seek care and remind them throughout the year, not just during open enrollment.
• Highlight Preferred-Value Providers or Tier 1 providers regularly and explain why they offer better value.
• Give employees simple scripts to use when scheduling care to find out if the clinician is in-network.

When people understand their options and the decision feels easy, they’re far more likely to choose in-network care.

Help Employees Avoid Surprise Medical Bills with Facility Fee Awareness

Facility fees are one of the biggest drivers of surprise bills today. Many employees don’t realize that:

• A hospital-owned clinic may charge a facility fee, even for basic services
• MRIs, lab work, and procedures can cost thousands more in a hospital outpatient setting than an independent facility

To help employees avoid facility fees, employers can encourage them to ask one simple question before scheduling any service:

“Do you charge a facility fee for this appointment or procedure?”

Other helpful strategies include:

• Sharing a list of independent, Preferred-Value Providers that do not charge facility fees
• Promoting care navigation services that can verify costs and in-network status on the employee’s behalf
• Giving employees the tools to compare costs for imaging, labs, and minor procedures. The Alliance’s Smarter Care Advisor allows users to filter providers by high, medium, and low cost and location.

Giving employees the information and tools they need to make informed decisions removes uncertainty gives them and confidence needed to make smarter healthcare choices.

Use Stories and Real Experiences to Make Change Feel Practical

We often think data drives behavior, but in healthcare, people respond more strongly to real stories. When employees hear how a coworker avoided a costly bill simply by asking about facility fees, or saved hundreds by choosing an independent imaging center, the concept of shopping for care becomes concrete and relatable. 

Real examples shrink the psychological distance between employees and the behavior you want them to adopt. Real examples transform an abstract idea into something people can imagine themselves doing. 

Employers can encourage: 

• Testimonial sharing in staff meetings
• Internal newsletters featuring real savings stories
• Departmental conversations about choosing high-value healthcare

These small nudges reinforce that these choices are normal and achievable.

Promote Care Navigation Tools That Reduce Surprise Medical Bills

Even highly engaged employees may not feel comfortable calling a provider’s office to ask about network status or facility fees. That’s why care navigation resources are so valuable.

Care navigation can help employees:

• Confirm in-network status
• Identify clinics that do not charge facility fees
• Compare costs
• Schedule appointments
• Guide employees to Preferred-Value Providers for imaging, procedures, or preventive care

These tools not only reduce uncertainty but also lower resistance because employees are more likely to be engaged if they feel supported and informed rather than pushed.

Use Benefit Design to Encourage Healthcare Consumerism

Self-funded employers have the advantage of designing benefits that reward smarter decisions and reduce unnecessary costs through steering and tiering. This includes encouraging employees to take earlier action on high-cost conditions, prioritizing provider network design, and focusing on preventive care measures.

Employers can also leverage digital health tools to guide employees toward high-value care, providing transparency and supporting informed healthcare decisions. The nested table to the right illustrates key steps in benefit design that drive engagement and cost savings.

• Offering care from Preferred-Value Providers at low or no cost to employees
• Adding cash incentives outside the benefit plan for employees who choose Preferred-Value Providers

Benefit design can remove friction by making the best option also the easiest and most affordable.