We address the billing problem with the U.S. healthcare system.
We’ve developed partnerships to provide a proactive approach to medical billing, negotiating with medical providers, prior to service, to get the lowest possible cost. We understand and use the cost difference between network prices as well as the medicare allowed amount to negotiate a steeply discounted cash price. And typically we’re able to eliminate your employees out of pocket costs as well.
Our team will be happy to share with you actual claims results, the tremendous difference between the provider’s full, or before network discount price, the network discount rate, and then what was actually negotiated and paid. Overall, just one seventh of the full price and just over a third of what would have been paid with the network discount.
We’re saving our clients an average of $1,500 per employee, each year.
Direct Hospital Agreements
A common approach for proactive pricing or value based pricing plans focus on the four primary cost drivers that make up 90% of the cost of your health plan.
Administrators use a strategy to form direct agreements with; hospitals, specialist and labs where group members live for pre-arranged pricing that eliminates the need to negotiate on a case by case basis.
Prescription drug costs make up 30% or more of the total health benefit costs. Drug claims from just one member on a plan can be in the tens of thousands of dollars.
There are rebates and discounts that are paid to Pharmacy benefit managers from the pharmaceutical companies, and it's probably the most convoluted part of the whole healthcare system, when you pull back the curtain and see what is actually going on.
Plans will handle this differently but some plans will use a transparent pricing model on drugs through some form of pharmacy benefit management, negotiating and ensuring the lowest possible cost on drugs, and passing all discounts and rebates back to the plan holder, they go back to the employer. This practice in itself can reduce prescription drug costs by as much as a third.
In-house HealthCare Advocates help you and your employees to navigate through the healthcare system and find the best care.
Only licensed administrators have access to the most accurate data.
Concierge Medicine / Direct Primary Care
In addition to the member advocacy groups some plans also provide an on-call service.
Keep in mind that not all of these services are the same. Where some on-call services are covered by a registered nurse, a PA or a Nurse Practitioner others provide direct access to a medical doctor made available, 24-7, by phone, video chat, and even by text messaging. These services don’t replace any doctors that members want to see. The added benefit to doctor provided services vs. the Nurse Practitioner or PA is a member has 24-7 access to a doctor who knows them, has their medical history and can coordinate their care between their other medical providers. To further differentiate this service some plans assign one doctor to a group so members interact with the same doctor every time.
Doctors can also get wholesale pricing on labs and imaging, and they can negotiate with the specialists, surgeons, anesthesiologists, hospitals… whatever care is needed. Keeping the claims costs down, way down.
Members can use concierge medicine as a centerpiece for their health plan and many wind up primarily using their concierge doctor as they can access them easier than their primary care physician who’s next available appointment may be a month out.
Request a free Healthcare Benefit Plan evaluation.
As the labor market shifts the more valuable a rich employee benefit package becomes.
Or Call Us at 1-800-488-5798