Podcast

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 you are receiving the best possible audit outcome of paid claims. Frequently, those big names just come with a fancy cover page, but not necessarily the industry expertise needed for the best outcome for you as the client. You want to be sure you are hiring specialists with industry-specific expertise gained from years of examining every possible type of dataset. Hiring Healthcare Horizons ensures you get the expertise you need.

Healthcare Horizons, with our 100% Difference approach, provides the most comprehensive audit possible. We review the full sample size allowed by the administrative services agreement instead of a predetermined amount that our competitors are “comfortable” with. In addition, we promise executive experience and expert eyes on each and every audit, rather than heading off to a site visit with a computer generated list of possible claim errors. Healthcare Horizons’ expertise allows us to review claims with the best probable error to ensure the most recoveries for our clients. Our methods allow us to identify more systemic errors. Correcting those expertly-identified errors saves our clients hundreds of thousands of dollars over time.

Don’t pay for a fancy report with an expensive cover. Get what you pay for by hiring the expert in the field. There is no extra charge for our cover page. 

The Difference is in Knowing.

To learn more about our approach to healthcare claims auditing or out-of-network provider fee negotiation services, visit Healthcare Horizons, or reach out to us at hhadmin@healthcarehorizons.com. 

Randy King is president of Healthcare Horizons Consulting Group, Inc. The company is one of the nation’s leading healthcare claims auditing firms, focused exclusively on self-insured employers since 1999. Healthcare Horizons has recovered millions of dollars for its clients through auditing and air ambulance negotiations for some of the world’s largest employers.

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 to protect their stakeholders, including monitoring the healthcare claims payments made by their TPA.  I was rather surprised by the response I got:

“We don’t need an audit, our TPA has us covered. They look at all that for us, and we don’t need to worry about it.”

Unfortunately, that is not the case. While claims payers generally do a good job on behalf of their clients, people make mistakes. Healthcare Horizons has recovered more than $250 million in overpaid healthcare claims. Mistakes can add up over time and the loss can be significant. It is crucial that self-insured employers conduct annual healthcare claims audits because one of the unintended consequences of self-insuring is that claims payers have no financial incentive to control medical costs.

At Healthcare Horizons, our top priority is to protect our clients’ financial interests by ensuring that their medical claims payments are being paid as accurately as possible. So when you say, “Our TPA has us covered” – are you sure? 

Errors Happen. People Are Not Perfect.

To learn more about our approach to healthcare claims auditing or out-of-network provider fee negotiation services, visit Healthcare Horizons, or reach out to us at hhadmin@healthcarehorizons.com.

Randy King is president of Healthcare Horizons Consulting Group, Inc. The company is one of the nation’s leading healthcare claims auditing firms, focused exclusively on self-insured employers since 1999. Healthcare Horizons has recovered millions of dollars for its clients through auditing and air ambulance negotiations for some of the world’s largest employers.

You focus on protecting your employees’ health. We will focus on protecting your healthcare plan.

As we navigate through new ways of working and being with our loved ones while addressing COVID-19, know that we are here to help. Our primary concern now is the health and well-being of our families and friends, employees, and the people we serve. Our self-insured clients are possibly facing great upheaval and uncertainty in the months to come, and we are mindful of doing our part to help them weather this time successfully. Knowing we are looking out for the health and accuracy of your healthcare claims payments at this difficult time will allow you to keep the focus on the health and safety of your people.

As business leaders, we understand that your concerns, like ours, are both immediate and long-term. Let us know if you have questions or if we can help as you peer into the future of what business looks like after the pandemic. The healthcare plans you provide are vital to the way you support your employees, and we are here to be sure your plans stay healthy, effective and sustainable for years to come.

Our thoughts are with you at this difficult time. Remember, we are all in this together.

The Difference is in Knowing.

To learn more about our approach to healthcare claims auditing or out-of-network provider fee negotiation services, visit Healthcare Horizons or reach out to us at hhadmin@healthcarehorizons.com.

Randy King is president of Healthcare Horizons Consulting Group, Inc. – performing healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.