Last month, we examined a few of the top categories of claims payment errors. Because every healthcare claims data set has errors — people make mistakes — it is important for self-insured employers to perform an independent, fully comprehensive audit annually to identify errors, correct systemic issues for future savings and recover claims that were … Read more
In this two-part series, we will examine a few of the top categories of claims payment errors. Missing these common errors means that self-insured employers are leaving possibly hundreds of thousands of dollars on the table every year.Rather than asking your employees to contribute more in terms of higher premiums or reducing their benefits, self-insured … Read more
The current practice of “balance billing” allows health care providers to charge the insured employee for the balance of a medical bill when an insurance company does not pay the full amount. Surprise bills can be the result of an insured unknowingly receiving medical services from an out of network provider. These unexpected bills can … Read more
Oftentimes we believe that if we pay more for something, we can expect to receive a product of higher quality or features. While that is sometimes true, in many instances you may just be paying for a name. When it comes to healthcare claims auditing, looking for the most familiar name does not ensure that … Read more
With a difficult and challenging year coming to a close, many people are taking stock of both the things we look forward to leaving behind as we move into 2021 (toilet paper shortages, staycations and Zoom meetings!) as well as the silver linings that 2020 revealed. A crisis often makes abundantly clear that our former … Read more
The recent article, A $52,112 Air Ambulance Ride: Coronavirus Patients Battle Surprise Bills, reports that about 450,000 Americans have been hospitalized with coronavirus. Even those with strong employer-provided health insurance can be hit with huge surprise bills from out-of-network providers such as air ambulances. The results can be financially devastating and an undue burden on … Read more
While attending a conference last year, I engaged in conversation with a benefits manager from a large company. I pointed out that Healthcare Horizons could find not only current savings for his company, but possibly future savings. I also reminded him that a self-insured employer has a duty of care as fiduciary of their plan … Read more
Air ambulance flights save many lives each year. Because air ambulance providers and insurers cannot always agree on a fair price, many air ambulance providers remain out of network. These out-of-network charges — often in excess of $50,000 — may result in “surprise” out-of-pocket bills for tens of thousands of dollars for your employees. Roughly … Read more
Remember that feeling of finding a forgotten $20 bill in your coat pocket when the first cold snap of Fall comes? Discovering something of value that was there all along can really make your day. As self-insured companies face economic uncertainty in the current environment, finding money that was there all along can boost an … Read more
As self-insured companies attempt to reckon with the current pandemic, rising healthcare costs is on everyone’s mind. Although it’s impossible to tell the future in such unprecedented times, there is a growing consensus that costs will rise and self-insured employers will be laser-focused on new and existing ways to control them. In the article What … Read more