The Business of Benefits Podcast

The Business of Benefits Podcast The Business of Benefits is where employers go to learn the truth about healthcare and employee benefits. We’re here to prove otherwise.

For decades, HR leaders, CFOs, and CEOs have been told they can’t control healthcare costs.

06/03/2026

The average mental health claim on a zero-barrier plan: $129.
The average cost of a 30-day inpatient psychiatric stay: tens of thousands of dollars.

One of those outcomes happens when people get help early. The other happens when they can't.

Over 2.7 years, one of our clients, a manufacturing company with 350–380 employees, processed 594 mental health claims with zero member out-of-pocket cost. No copays. No deductibles. Unlimited sessions. Open network. No prior auth.

Total annual plan cost for mental health? $28,745. That's 2.2% of total paid claims. $7 per employee per month.

Meanwhile, traditional plans, the ones with all the restrictions, the session limits, the $50 copays, the prior auth requirements, benchmark at $14 to $17 PEPM for mental health.

The plans designed to limit access to care are costing employers MORE.
Because here's what actually happens when you restrict mental health benefits: people delay care. They push through. They manage. Until they can't. And when they can't, the claims aren't $129 anymore.

Watch the full data breakdown here 👇 https://vist.ly/56gdd

If your broker is selling you on restrictions as a cost-saving strategy for mental health, ask them to show you the data. Because ours says the opposite.

Prior authorization exists to protect the plan and the patient.That's the official answer.Here's what Chelsea Ryckis sai...
06/01/2026

Prior authorization exists to protect the plan and the patient.
That's the official answer.

Here's what Chelsea Ryckis said on Episode 78 of The Business of Benefits — and it's worth sitting with:

"Pre-authorization is supposed to protect the plan and the patient. But a lot of the times, it's acting as a barrier to care — and there's a lot of information out there about how it's been used by large insurance companies specifically to control cost and inhibit the care people actually need."

For mental health in particular, this matters.

Someone finally works up the courage to see a specialist. Or they're in crisis and need intensive care. And before anything happens, the plan requires them to get approval first.

That delay isn't neutral. For someone already struggling, it can be the reason they stop trying.

The case study Chelsea shared removed pre-authorization entirely for mental health. The result wasn't a runaway claims problem. It was 594 claims. $129 per claim. 41 employees who actually got the care they needed — some of them for the first time.

If your plan uses pre-auth as a mental health cost control lever, it's worth asking: is it actually protecting anyone? Or is it just making care harder to reach?

05/29/2026

Most employers think offering mental health coverage means having a plan that technically covers it.

There's a massive difference between coverage that technically exists and coverage that actually works.

Here's what "technically covered" looks like on most shelf plans: $25–$75 copay per visit. 20–40% coinsurance after deductible. Session limits of 6–8 per year. Prior authorization required for specialists. Narrow behavioral health network.

And here's what one of our clients chose after looking at their claims data and deciding to do something different:
$0 copay. 0% coinsurance. $0 deductible. Unlimited sessions. No prior auth. Open network — see anyone you want, we pay.

Same employer. Same workforce. Completely different design philosophy.
The result? 12% utilization versus a 4% national benchmark. 41 employees got real help. 594 claims processed. Average of 14 sessions per member. Total cost: $7 per employee per month.

That employer was also named a USA Today Top Workplace 2025 and ranks in the top 1% of trust in leadership.

Full episode 👉 https://vist.ly/55yam

When you make mental health zero dollars, you're not just changing a line item on a plan document. You're telling your workforce: we see you, we care, and we're not going to make you prove you're struggling badly enough to deserve help.

That message travels. And it stays.

What does your current mental health plan design look like? Would your employees describe it as "technically covered" or actually accessible?

Here's the logic most employers follow on mental health benefits:Limit the sessions. Require pre-auth. Keep the cost-sha...
05/28/2026

Here's the logic most employers follow on mental health benefits:
Limit the sessions. Require pre-auth. Keep the cost-sharing high. Control the spend.

It makes sense on paper. It doesn't hold up in the data.
Chelsea Ryckis broke it down on Episode 78 of The Business of Benefits using nearly three years of real claims data from a 350–380 person manufacturing company.

The result?
The plan that opened mental health completely — zero cost-share, unlimited sessions, open network — came in at $7 per employee per month.

Traditional plans, with all the friction built in, benchmark at $14–$17 PEPM.
The restricted plans cost more. Because restriction doesn't reduce need. It just delays it.

"It's far more effective, affordable, and practical to support your entire population and design around what they actually need than to restrict it thinking it's going to save you money. What ends up happening is people delay care — and the claims are much more catastrophic than they need to be."

A $129 outpatient claim vs. a 30-day inpatient stay.
Those are the real numbers you're choosing between.
Full episode: https://vist.ly/55seu

05/27/2026

Your TPA told you your plan is compliant. Have you actually verified that?
The Mental Health Parity and Addiction Equity Act has been federal law since 2008... updated again in 2024.

It says mental health and addiction treatment must be covered the same way as physical health on your plan. Same copays. Same deductibles. Same prior auth rules. Same visit limits.

And yet compliance violations in this area are some of the most common issues we see, on plans where everyone had good intentions and nobody looked closely enough.

Here's a quick audit starting point:
→ Confirm parity compliance with your TPA in writing. Verbal assurances don't go in your fiduciary file.
→ Upload your plan documents into an AI and ask if you're meeting MHPAEA requirements. It won't replace expert review but it'll surface issues fast.
→ Request your NQTL comparative analysis. It's required under the CAA of 2021.
→ Review behavioral health network adequacy vs. your medical network. A wide medical network and a narrow mental health network is a compliance problem.
→ Audit your EAP or carve-out vendors if they're the sole source of mental health benefits in your program.

DOL and HHS enforcement is increasing. Audits on self-funded plans are up. "My carrier said we're good" is not a defense.

Full episode here 👉 https://vist.ly/55mqc

This one is worth a save. Share it with your HR team or your broker and ask them to walk you through each step.

You might not be able to change your plan design right now.Maybe the renewal isn't for six months. Maybe the budget conv...
05/26/2026

You might not be able to change your plan design right now.

Maybe the renewal isn't for six months. Maybe the budget conversation hasn't happened yet. Maybe you're still gathering data.
That's okay.

Watch the full episode:
https://vist.ly/55jnm

But here's what Chelsea Ryckis said that applies regardless of where you are in the process:
"If you can't afford to change your plan design or bring in a vendor, you can still control your culture. You can control how you approach these conversations. You can make mental health more of the norm. You have that power, at the very least."

85% of workers report burnout or exhaustion. 47% have already taken time off for mental health reasons. And most of them are doing it silently because they're not sure if it's safe to say something.

That changes with leadership. With how managers respond when someone's struggling. With whether mental health is treated like a real business issue or something that gets handled quietly in HR.

You have more influence over that than you might think.

Start there. And when the plan design conversation is ready, have it with data.

05/26/2026

Prior authorization was designed to protect patients.
https://vist.ly/55iqi

That's the pitch anyway.

In practice — especially in mental health — prior auth has become one of the most effective tools large insurance companies use to control claim spend by denying or delaying care people genuinely need.

Think about what this looks like for your employee. They've finally worked up the courage to seek help. They found a provider. They scheduled an appointment. And then they're told: you need prior authorization before we'll cover this.

So now they're waiting. Filing paperwork. Getting denials. Filing appeals. And somewhere in that process — statistically — a meaningful percentage of them just stop.

They don't get better. They delay care. And delayed care in mental health doesn't just mean suffering longer. It means what would have been a $129 outpatient claim becomes a 30-day inpatient stay.

The same dynamic plays out with narrow behavioral health networks. When the in-network options are limited — and most specialized mental health providers don't take insurance anyway — "your plan covers mental health" becomes a technicality, not a reality.

One of our clients eliminated prior auth for mental health entirely. Open network. See anyone you want, we pay.

594 claims. $129 average cost per claim. $7 per employee per month.
The system that was supposed to protect the plan was costing it more.

There's a federal law most employers don't fully understand and their TPA might not be flagging it.It's called the Menta...
05/25/2026

There's a federal law most employers don't fully understand and their TPA might not be flagging it.

It's called the Mental Health Parity and Addiction Equity Act. Passed in 2008, updated in 2024. And it says this:

Mental health and addiction treatment must be treated the exact same way as physical health in employer-sponsored plans.

Same co-pays. Same deductibles. Same visit limits. Same pre-authorization rules.

Chelsea Ryckis walked through the most common pitfalls she's actually seen on real plans in Episode 78 of The Business of Benefits:
More restrictive prior auth for mental health than for medical care. Narrower provider networks. Less reimbursement for therapy than for procedures. Different step therapy requirements for mental health medications.

These aren't edge cases. They show up on plans where the TPA already signed off on compliance.

Employers with 50+ employees are required to comply. DOL and HHS enforcement, especially for self-funded plans, is increasing.

The fix isn't complicated. Confirm compliance with your insurer or TPA. Get it in writing. Document it. And if you're self-funded, request the NQTL comparative analysis now required under the CAA- keep in mind this can sometimes come with quite the price tag depending on the size of the company.

And as Chelsea put it: the ROI to invest in mental health is there.
Full episode: https://vist.ly/55eix

05/22/2026

98% of mid-to-large employers offer an EAP.
4% of employees use it.

Full episode: https://vist.ly/557nj

Let that sit for a second.

You're paying for a benefit that the vast majority of your workforce isn't touching — and when someone IS struggling, the advice they get is "just reach out." As if knowing the 1-800 number is the barrier standing between them and getting help.

Here's what's actually in the way:
Stigma. "Will my employer know I called?" Wait times. Mental health providers are overwhelmed and many have months-long waitlists. Out-of-network providers. A huge portion of therapists and psychiatrists don't take insurance at all, meaning your "covered" benefit is effectively useless for the specialists people actually need. Session limits. Six to eight visits a year isn't treatment. For someone dealing with generalized anxiety, bipolar disorder, or trauma... that's barely an intake.

An EAP is not a mental health strategy. It's a checkbox.

The employers who are actually moving the needle on workforce mental health are making it structural. They're embedding it into the plan design — removing copays, deductibles, session limits, and prior auth requirements so that access is real, not theoretical.

Your employees aren't struggling less than you think. They're just struggling silently because the system you built made asking for help feel harder than staying quiet.
That's fixable. And the ROI is there.

Not every employer can redesign their health plan tomorrow.Some are mid-contract. Some are working within tight budgets....
05/22/2026

Not every employer can redesign their health plan tomorrow.
Some are mid-contract. Some are working within tight budgets. Some are still building the business case.

But here's what Chelsea Ryckis said near the end of Episode 78 of The Business of Benefits and it's worth sitting with regardless of where you are in the process:

"The more open you can be with your teams about mental health that it's okay if somebody's struggling, that you support them, that you see them, that goes a lot further, honestly, than any plan design decision could. That cultural component of being a human and really valuing people — that's something every employer controls right now."

At Ethos, mental health days don't count against PTO. Someone needs a day — they ask, they take it, no questions.

That costs nothing to implement.
The plan design matters. The data proves it. But culture is the thing that determines whether employees believe the benefit is actually for them — or whether they'll stay silent anyway.

Both levers matter. You don't have to wait for open enrollment to pull one of them.

Episode 78: https://vist.ly/556q3

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