Network Access Fee

A network access fee is what a self-funded plan pays to use a provider network's contracted rates. It's charged either as a flat amount per employee per month, or as a percentage of the "savings" the network claims to have produced, meaning the difference between billed charges and the contracted rate.

The percentage-of-savings version is the one to watch. If a hospital bills $100,000 and the network rate is $40,000, a fee of 15 to 30 percent of the $60,000 "saved" comes to $9,000 to $18,000, paid by the plan on top of the $40,000. The higher the hospital's billed charges, the larger the savings figure and the larger the fee, which means the plan is paying more precisely when the chargemaster is more inflated. These fees often appear on the claim itself rather than on the administrative invoice, so a plan sponsor reviewing PEPM fees may never see them. On a mid-size plan they can add 2 to 5 percent to total claims cost. Secondary networks used for out-of-network claims are usually priced this way too.

The takeaway: ask your administrator to show every network and repricing fee for the last twelve months, in dollars, whether it was charged on the invoice or on the claim. If they can't produce the number, the contract needs to change.