At face value, it seems logical that insurance companies are responsible for paying health benefit claims. But are they? Determining the entity responsible for paying claims requires an understanding of how health benefit plans are structured and … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part IV: Know Who Is Paying Your Claim?
By Leslie Howard
Class Action Suit Filed Against UHC for Denied Breast Reconstruction Medical Claims
We are pleased to share news of a class-action lawsuit filed against United Healthcare (UHC), in a New Jersey federal court, concerning its ongoing denial of reimbursement for co-surgeons (CO) and assistant surgeons (AS) when performing a DIEP Flap … [Read more...] about Class Action Suit Filed Against UHC for Denied Breast Reconstruction Medical Claims
Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part III: How to Decode the True Maximum Value of a Medical Claim
True Market Value® is pricing tool developed by the car industry (Edmunds) to help consumers navigate the complicated process of negotiating a fair price for a new or used car. This concept can be adapted by out-of-network providers to calculate the … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part III: How to Decode the True Maximum Value of a Medical Claim
Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part II: Verification of Benefits — A Vital Process Re-Examined
While most practices understand, the first step towards obtaining optimum reimbursement from an insurance company is to operationalize a consistent and timely verification process. Even with a process in place to verify benefits, however, it is not … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part II: Verification of Benefits — A Vital Process Re-Examined
Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part I: The All Powerful In-Network Exception
An often-underutilized and misunderstood strategy for maximizing out-of-network provider reimbursements for surgical services is the ‘in-network’ or ‘gap’ exception that can be authorized by health insurance companies on a case by case basis. … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part I: The All Powerful In-Network Exception
