At USBenefits, we believe the goal of cost containment is to ensure the Plan is not paying for any services that are excluded according to the Plan document. This means not only looking for billing errors, but also treatment misadventures that could cost the Plan tens of thousands of dollars more than necessary. At USBenefits, we review every claim notice and reimbursement request to see if there is an opportunity for cost savings. This process helps us get in front of claims prior to payment as we can work with the TPA to gather the documentation necessary to closely review claims.
In our most recent Claim Success Story, USBenefits, in partnership with our vendor and the TPA, was able to obtain a provider refund for the Plan for unnecessary treatment. You read that right! A provider admitted they were wrong and refunded the Plan!
As we’ve all heard that providers, with the support of their networks, try to make it as difficult as possible to audit their bills. They do this by insisting that the claim be paid first before you can audit the claim. So, what happens next? The bill is paid, and the provider makes it very difficult to contact anyone at the hospital to discuss the bill audit. As they say, whoever has the money, has the power.
At USBenefits we don’t give up that easily. If something is wrong, we will pursue it to resolution. Thankfully, we partner with vendors that have the same mindset. In this specific case, the vendor bill audit clearly showed the hospital did not follow the proper protocols and kept the patient in the hospital five days longer than necessary. After many calls, over many months, the vendor was able to get the right people at the hospital on a conference call to resolve the dispute. The provider agreed to refund the Plan for the five days that were not medically necessary. A huge win for the Plan! Every dollar USBenefits can save through our cost savings strategy has a direct impact on the Plan’s renewal. Check out more success stories at https://www.usbstoploss.com/about-us/blog/
At USBenefits, your goal is our goal, to provide the best possible outcome for the employer.