{"id":30191,"date":"2026-10-14T00:28:44","date_gmt":"2026-10-14T04:28:44","guid":{"rendered":"https:\/\/smithdirectcare.com\/?p=30191"},"modified":"2026-10-15T06:46:29","modified_gmt":"2026-10-15T10:46:29","slug":"open-enrollment-is-the-wrong-time-to-discover-your-surgical-benefit-isnt-working","status":"publish","type":"post","link":"https:\/\/smithdirectcare.com\/es\/open-enrollment-is-the-wrong-time-to-discover-your-surgical-benefit-isnt-working\/","title":{"rendered":"Open Enrollment Is the Wrong Time to Discover Your Surgical Benefit Isn\u2019t Working"},"content":{"rendered":"<p>It\u2019s open enrollment season. HR teams are fielding questions about deductibles, comparing plan tiers and reminding employees to make their elections before the deadline. Most of that attention goes to premiums and paycheck deductions.<\/p>\n<p>Surgical care rarely gets the same scrutiny. It tends to come up only after a large claim arrives, an employee puts off a needed procedure, or the renewal shows the impact. Yet surgery is one of the most expensive and least predictable items in an employer\u2019s health spend.<\/p>\n<p>If your benefits strategy for the coming plan year doesn\u2019t include a clear, affordable path to surgery, open enrollment is a good time to ask why.<\/p>\n<h2>The numbers employers are carrying into the new plan year<\/h2>\n<p>los <a href=\"https:\/\/www.kff.org\/health-costs\/issue-brief\/2025-employer-health-benefits-survey\/\">KFF 2025 Employer Health Benefits Survey<\/a> shows how much pressure employers and employees are already under:<\/p>\n<ul>\n<li>The average annual premium for employer-sponsored family coverage reached <strong>$26,993<\/strong>, up <strong>6%<\/strong> from 2024.<\/li>\n<li>Workers contributed an average of <strong>$6,850<\/strong> toward that family premium.<\/li>\n<li>The average single-coverage deductible was <strong>$1,886<\/strong>, y <strong>34%<\/strong> of covered workers had a single deductible of <strong>$2,000 or more<\/strong>.<\/li>\n<li><strong>One-third<\/strong> of covered workers were enrolled in a high-deductible plan with a savings option.<\/li>\n<\/ul>\n<p>Employers pay more every year, and employees pay more before their coverage starts. When an employee needs surgery, both sides feel it.<\/p>\n<h2>A benefit on paper isn\u2019t a benefit in practice<\/h2>\n<p>Offering a benefit doesn\u2019t mean employees use it well. Castlight Health\u2019s 2026 Employer Health Benefits Experience Survey of 2,000 workers, <a href=\"https:\/\/worldatwork.org\/publications\/workspan-daily\/out-of-pocket-out-of-touch-why-workers-are-bypassing-your-benefits\">reported by WorldatWork<\/a>, found that <strong>a third of workers bypass their employer benefits entirely<\/strong> and build their own do-it-yourself workarounds. It also found that <strong>29% spend more than $500 a year<\/strong> out of pocket on items their employer likely already covers.<\/p>\n<p>With surgery, that gap tends to show up in a few ways:<\/p>\n<ul>\n<li>Employees <strong>delay a needed procedure<\/strong> because they\u2019re worried about the deductible, and the condition gets worse and more expensive.<\/li>\n<li>Employees go to the <strong>default hospital option<\/strong> because nobody showed them an alternative, and the plan pays inflated facility rates.<\/li>\n<li>Employees get <strong>separate bills<\/strong> from the surgeon, anesthesiologist and facility, and the confusion turns into frustration with the benefits package and the employer.<\/li>\n<\/ul>\n<p>We call this the utilization gap: the distance between the coverage employers pay for and the care employees actually get, at a price that makes sense.<\/p>\n<h2>Why surgery is where the gap costs the most<\/h2>\n<p>Surgical claims are high-dollar and hard to predict. One procedure billed at traditional hospital rates can change a self-funded employer\u2019s year, push toward stop-loss thresholds and show up again at renewal. Prior authorizations and scheduling delays also keep employees out of work longer than necessary.<\/p>\n<p>That makes surgery one of the clearest opportunities to lower cost and improve the employee experience together.<\/p>\n<h2>What a working surgical benefit looks like<\/h2>\n<p>Smith Medical Direct Specialty Care in Littleton offers a direct-pay surgical model built for self-funded employers and cost-conscious benefit strategies:<\/p>\n<ul>\n<li><strong>One bundled, all-inclusive price.<\/strong> Surgeon fees, anesthesia, facility fees, and standard labs and supplies are included up front. There are no separate bills.<\/li>\n<li><strong>Typically 40\u201360% less than traditional hospital billing.<\/strong><\/li>\n<li><strong>Predictable costs.<\/strong> Bundled pricing reduces claim volatility and large-claim surprises that affect stop-loss and renewal rates.<\/li>\n<li><strong>Faster access.<\/strong> No prior authorizations means employees get care sooner and return to work sooner.<\/li>\n<li><strong>Board-certified surgeons.<\/strong> Employers don\u2019t have to give up quality to save money.<\/li>\n<li><strong>Works with your existing strategy.<\/strong> Smith\u2019s transparent pricing fits self-funded plans, high-deductible plans, cost-sharing programs and innovative benefit platforms.<\/li>\n<\/ul>\n<blockquote><p>\u201cEmployers don\u2019t need another benefit their people don\u2019t use. They need a surgical option that\u2019s simple enough to explain at open enrollment and affordable enough that employees actually choose it.\u201d<br \/>\n<strong>\u2014 Lisa Fagan, CEO, Smith Medical Direct Specialty Care<\/strong><\/p><\/blockquote>\n<h2>Five questions to ask during open enrollment<\/h2>\n<p>Whether you manage benefits in-house or work with a broker, these questions show whether your surgical benefit is doing its job:<\/p>\n<ol>\n<li>Could an employee find out what a common procedure, such as a knee arthroscopy or carpal tunnel release, would cost them <strong>before<\/strong> scheduling it?<\/li>\n<li>Does your plan include a <strong>bundled or direct-contract surgical option<\/strong>, or does every procedure default to hospital billing?<\/li>\n<li>If you have a lower-cost option, is it <strong>explained in your open enrollment materials<\/strong>, or does it only come up after an employee asks?<\/li>\n<li>How many <strong>large surgical claims<\/strong> did your plan absorb last year, and what did they do to your renewal?<\/li>\n<li>Has your <strong>benefit advisor<\/strong> brought you transparent-pricing alternatives for surgical care?<\/li>\n<\/ol>\n<p>If you answered \u201cno\u201d or \u201cI\u2019m not sure\u201d to two or more of these, there\u2019s probably room to improve.<\/p>\n<h2>Close the gap before the next claim arrives<\/h2>\n<p>Open enrollment is the one time of year employees pay close attention to their benefits. It\u2019s also a good time for employers and benefit advisors to make sure the surgical benefit holds up, so employees have a clear, affordable option when they need a procedure.<\/p>\n<p>Smith Medical works directly with self-funded employers and benefit advisors to build transparent surgical pricing into their benefit strategy.<\/p>\n<p><strong>Call the Benefits Advisor Hotline at 720-912-8289<\/strong> o <a href=\"https:\/\/www.smithdsc.com\/contact-us\/for-employers\/#contact\">contact our employer team<\/a> to see what bundled surgical pricing could save your organization or your clients.<\/p>\n<p>Our prices are all-inclusive. Learn more at <a href=\"https:\/\/www.smithdsc.com\/pricing-disclaimer\/\">smithdsc.com\/pricing-disclaimer<\/a>.<\/p>\n<h2>Sources<\/h2>\n<ol>\n<li><a href=\"https:\/\/www.kff.org\/health-costs\/issue-brief\/2025-employer-health-benefits-survey\/\">KFF \u2014 2025 Employer Health Benefits Survey<\/a><\/li>\n<li><a href=\"https:\/\/worldatwork.org\/publications\/workspan-daily\/out-of-pocket-out-of-touch-why-workers-are-bypassing-your-benefits\">WorldatWork \u2014 \u201cOut of Pocket, Out of Touch: Why Workers Are Bypassing Your Benefits\u201d (May 27, 2026), reporting Castlight Health\u2019s 2026 Employer Health Benefits Experience Survey<\/a><\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"<p>It\u2019s open enrollment season. HR teams are fielding questions about deductibles, comparing plan tiers and reminding employees to make their elections before the deadline. Most [&hellip;]<\/p>\n","protected":false},"author":26,"featured_media":30192,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-30191","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v22.1 (Yoast SEO v28.1) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Open Enrollment Is the Wrong Time to Discover Your Surgical Benefit Isn\u2019t Working | Smith Direct Care %<\/title>\n<meta name=\"description\" content=\"It\u2019s open enrollment season. 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