Two heavyweights will be duking it out in the court system over problems with access to claim information as Kraft Heinz is suing Aetna over lack of access to critical data.

Most large companies often self-insure their health plan. This means that they are responsible for paying claims up to a certain amount before separate insurance often kicks in called stop-loss. Since most businesses are not in the business of insurance they often partner with what is called a Third Party Administrator (TPA) to process and pay claims.

Large insurance companies often also offer TPA services since they have the infrastructure in place. In order for this relationship to be successful it has to have transparency on both sides.

Employers who are concerned about their healthcare costs will want to look at their claims history to see if there are any areas where they can control costs. The problem is when they are unable to get this information there is nothing they can do.

This seems to be the heart of the issue between these two companies as Kraft Heinz is alleging that Aetna is withholding this important data.

You can read more here... https://www.jdsupra.com/legalnews/kraft-heinz-sues-aetna-raising-novel-8183158/https://www.benefitspro.com/2023/07/05/kraft-heinz-accuses-aetna-of-fiduciary-breaches-412-150903/