Who We Serve (Template) - Self Funded Plans

Self-Funded Health Plans

You Took on the Risk. You Deserve Someone in Your Corner When Providers Push Back.

When a provider disputes a payment, balance bills a member, or initiates a federal IDR arbitration case, most plan sponsors don't have the internal resources to respond. aequum does. We provide medical billing defense and No Surprises Act IDR defense specifically for self-funded plans, so disputes get handled and the plan stays protected.

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The Reality of Self-Funding

Self-funding gives you leverage. It also gives you exposure most employers don't anticipate until something lands on HR's desk.

Out-of-network providers challenge plan payments. Members receive balance bills they don't understand and can't afford. The No Surprises Act created a federal arbitration process called IDR that providers are using aggressively to collect payments well above what the plan originally paid. Each of those situations has a clock on it, a paper trail requirement, and a real cost if it goes unmanaged.

Most plan sponsors deal with this reactively, if at all. The bill gets paid. The member gets frustrated. HR loses an afternoon. aequum exists to change that dynamic and be the resource your plan actually needs when the disputes start.

What We Do

Two services built for the disputes self-funded plans face.

Medical Billing Defense

We defend plans and members against inflated out-of-network bills, collections pressure, balance billing, and the noise that follows when disputes go unmanaged.

When a provider issues an inflated out-of-network bill or attempts to balance bill a member, we step in. We review the dispute, contact the provider directly, challenge improper charges, and manage the case through resolution. The plan is defended. The member isn't left navigating it alone.

Plan Participant Advocacy
Out-of-Network Negotiation
Overpayment Recovery

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No Surprises Act Defense

We manage the NSA IDR process for payers so you don't have to bear the administrative burden and risk of unfair or improper awards.

The No Surprises Act created an IDR arbitration process that providers are using to demand payments significantly higher than the plan's qualifying payment amount. We manage eligibility review, open negotiation, and IDR defense so your plan isn't exposed to unnecessary arbitration awards.

NSA Eligibility Review
IDR Process Management
Post-Award Advocacy

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Fiduciary Responsibility

ERISA requires plan sponsors to act prudently. That obligation doesn't stop at claims processing.

When a billing dispute goes unmanaged, when a member is balance-billed and no one responds, when an IDR case is filed and the plan misses a deadline, when there's no documentation of how disputes were handled, that's not just an operational problem. It's a fiduciary one.

aequum provides audit-ready reporting on every dispute we handle. You get a clear record of what happened, how it was addressed, and what the outcome was. That's the documentation ERISA fiduciary oversight requires, and it's built into everything we do.

What Our Partners Say

Trusted Across the Self-Funded Market.

Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.

Jim Farley

J.P. Farley Corporation

Results vary. Past results do not guarantee a similar outcome in any future matter.

We've been working with aequum for over 3 years and couldn't be happier. Their knowledge and advice has been invaluable to us as a Third Party Administrator.

Pat Sanders

Insurance Management Services, Inc.

Results vary. Past results do not guarantee a similar outcome in any future matter.

Aequum's expertise in balance billing disputes and IDR proceedings strengthens the foundation of the pricing solutions we deliver at ClaimsBridge. A trusted and highly valued partner in the self-insured market.

Kevin Gibson

CEO, ClaimsBridge

Results vary. Past results do not guarantee a similar outcome in any future matter.

Who This Is Built For

Self-funded plans aren't all the same. Here's where we typically see the most exposure.

Employer Plans

Mid to Large Employers Running Their Own Plan

You have enough claim volume that out-of-network disputes are a recurring reality, not a one-off. You need a consistent process for handling them, not a different response every time one shows up in HR's inbox.

RBP Plans

Reference-Based Pricing Plans

RBP plans pay providers a defined amount rather than contracting within a traditional network. It saves money. It also triggers provider pushback consistently. We defend RBP payment determinations and manage the balance billing disputes that follow so the plan operates without constant friction.

High OON Exposure

Plans With Significant Out-of-Network Claim Volume

If your plan has members who regularly access out-of-network care, billing disputes are predictable. Getting ahead of them with active defense is significantly cheaper than managing the fallout after the fact.

Frequently Asked Questions

Common questions from plan sponsors.

We're self-funded but we have a TPA managing our plan. Does that change how we work with aequum?

Not at all. We work alongside TPAs regularly. In most cases, disputes are referred to us through the TPA. We handle the advocacy and defense, document the outcome, and report back to both the TPA and the plan sponsor. The arrangement is straightforward to set up.

What does a typical dispute look like, and how does aequum get involved?

It usually starts one of two ways: a provider challenges the plan's payment directly, or a member receives a balance bill and contacts HR or the TPA confused about what they owe. From there, we review the bill, engage the provider, manage all communication, and work toward resolution. The plan sponsor doesn't have to touch the dispute directly.

How does the No Surprises Act affect our self-funded plan specifically?

The NSA protects your members from surprise bills for emergency and certain out-of-network services. But it also created the IDR process, which providers use to dispute what the plan paid. CMS data shows employer plans were involved in over 524,000 IDR disputes in just one quarter of 2025, a 119% year over year increase. When plans lose those disputes, they pay an average of 23 times the qualifying payment amount. Active defense isn't optional anymore.

What does audit-ready reporting actually mean for our plan?

Every dispute we handle is tracked, documented, and reported back to the plan sponsor. You can see what was filed, how we responded, and how it resolved. That paper trail matters for ERISA fiduciary compliance, and it's something most plan sponsors don't have without active dispute management in place.

Not Sure Where to Start?

Whether you're dealing with an active dispute or just trying to understand your plan's exposure, our team can walk you through it. No pressure. Just a straight conversation.

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