Most PPO and Insurance Company provider contracts require the payment of hospital charges with little or no ability to review, audit or challenge a charge. The fact is that approximately 90% of all medical bills have errors. Here’s an example of what is possible:
- Billed Charges = $452,981.69
- Carrier / PPO Allowed = $317,087.18
- After Audit Payment = $170,312.12
- Avoided Excess Cost = $146,775.06
There are several types of errors, including billing for services that were inappropriate for the diagnosis. To verify that only appropriate care was provided and billed, the review is carried out by board-certified practicing physicians.
The health care reimbursement system in place today serves the payers and the providers, not the employers. Don’t Trust, Verify.
Contact us for more information on cutting the waste out of your health plan expenditures.