September 2018 •
Volume 20 •
Issue 9
Providing Current Information on
Health Insurance Industry Issues and Legislation
Out-of-Network Claims Vex Employers
Almost one in five hospital admissions comes with bills from an out-of-network
(OON) provider. Even when the patient chooses an in-network facility, 15%
of admissions include a bill from an OON provider, according to a new Kaiser
Foundation analysis. Many times, surgeons and anesthesiologist at in-network
facilities are OON providers. Emergency room visit and treatments for mental
health and substance abuse are more likely to involve an OON provider, too. While
outpatient claims are less likely to involve an OON provider, 7.7 % of outpatient
"service days" still do. The result can be large "surprise" medical bills and potentially
huge out-of-pocket costs for payer and patients alike.
(OON) provider. Even when the patient chooses an in-network facility, 15%
of admissions include a bill from an OON provider, according to a new Kaiser
Foundation analysis. Many times, surgeons and anesthesiologist at in-network
facilities are OON providers. Emergency room visit and treatments for mental
health and substance abuse are more likely to involve an OON provider, too. While
outpatient claims are less likely to involve an OON provider, 7.7 % of outpatient
"service days" still do. The result can be large "surprise" medical bills and potentially
huge out-of-pocket costs for payer and patients alike.
Taking Big Bites Out of OON Claims
OON claims don't have to be a huge headache for payors or their plan enrollees.
HHC Group has been getting the OON bills reduced and the patient balance bills
eliminated for over 23 years. Our bulldog attorney negotiators are experts at
getting providers to sign agreements accepting an appropriate amount, usually
much lower that the billed amount, as payment in full. We also access our PPO
network partners to take advantage of their deepest discounts, again eliminating
those costly balance bills.
HHC Group has been getting the OON bills reduced and the patient balance bills
eliminated for over 23 years. Our bulldog attorney negotiators are experts at
getting providers to sign agreements accepting an appropriate amount, usually
much lower that the billed amount, as payment in full. We also access our PPO
network partners to take advantage of their deepest discounts, again eliminating
those costly balance bills.
ACA Enforcement Alert
While the individual mandate has been eliminated, the Affordable Care Act is still
the law. Employers still need to follow the rules this fall or face major penalties. The
IRS is enforcing "employer shared responsibility payment" penalties for employers
with 50 or more full-time or full-time equivalent employees. They are assessing
penalties with 226-J letters, scouring the 1094-C and 1095-C forms employers must
send and scrutinizing the new "Summary of Benefits and Coverage".
the law. Employers still need to follow the rules this fall or face major penalties. The
IRS is enforcing "employer shared responsibility payment" penalties for employers
with 50 or more full-time or full-time equivalent employees. They are assessing
penalties with 226-J letters, scouring the 1094-C and 1095-C forms employers must
send and scrutinizing the new "Summary of Benefits and Coverage".
How to Stop Overpaying for Healthcare Insurance
The cost of employee healthcare insurance will increase at 3 times the rate of inflation in
2019, hitting another all-time high. The estimated cost per employee will reach $14,800.
The conundrum is how to provide high quality care at the lowest possible rates. One
way for payers to rein in healthcare costs is to stop sending employees to high-cost, but
not high quality, providers. Another is to change their wellness programs if the ROI is
low or non-existent. A third is to look for other options or another benefit manager if
costs have gone up each of the last 5 years.
2019, hitting another all-time high. The estimated cost per employee will reach $14,800.
The conundrum is how to provide high quality care at the lowest possible rates. One
way for payers to rein in healthcare costs is to stop sending employees to high-cost, but
not high quality, providers. Another is to change their wellness programs if the ROI is
low or non-existent. A third is to look for other options or another benefit manager if
costs have gone up each of the last 5 years.
Three Star Preferred Provider Program Additions
|
Greenville, SC 29615 Tarzana Hospitalist Medical Corporation Tarzana, CA 91356 |
Houston, TX 77089 Beyond Innovation Chiropractic Frisco, TX 75033 |
