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Free-to-Employer, Healthcare Plan Negotiation Service to Reduce Plan Member Out-of-Pocket Expenses. HR Specialty Products & Services Catalogue Executive Summary A No Frills Distillation of Vendor’s Marketing Collateral Thomas A Ference President & CEO
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Free-to-Employer, Healthcare Plan Negotiation Service to Reduce Plan Member Out-of-Pocket Expenses HR Specialty Products & Services Catalogue Executive Summary A No Frills Distillation of Vendor’s Marketing Collateral Thomas A Ference President & CEO Human Resources Mining & Distribution Co Locating, Validating and Accelerating HR Innovation Office: 219-662-0201 Cell: 630-240-2583 Fax: 219-661-0236 e-mail: tference@hrmdco.com Website: www.hrmdco.com
High dollar deductible style healthcare benefit plans coupled with both plan member ignorance of the claims adjudication process and billing abnormalities made within a smoke and mirrors system of provider reimbursements can spell frequent overpayments by plan members in many, if not most instances. • This 25 year +old traditional claims negotiation services firm for payers realized 5+ years ago that plan members themselves can also be affected by inappropriate provider charges. • The service is provided no cost-to-employer and optional-to-member service allows. Free-to-Employer, Healthcare Plan Negotiation Service to Reduce Plan Member Out-of-Pocket Expenses
Members submit provider invoices and EOB‘s to a team of trained negotiators who contact the medical providers and propose a discounted member settlement based on normative databases of provider charges, previous member settlements, etc. • Only when and if successful, does the member pay and this is via sharing a percentage of the member’s negotiated savings with the negotiation vendor. • Member savings range from 0% to upwards of 60% with an average of 30% depending on the type of services rendered, the providers involved, the networks used and other factors Free-to-Employer, Healthcare Plan Negotiation Service to Reduce Plan Member Out-of-Pocket Expenses
Client has elective surgery at a cost of $13,936. Insurance adjustments / payments totaled $8,763 leaving a patient balance of $5,173. Settlement negotiation with the hospital leaves patient paying $3,750, for a savings of $1,423. • Clients father slipped and taken to the emergency room. X-rays, CT scan and stitches were part of the $3,634 bill to the patient. Vendor secured a patient savings of $1,454. • Client receives an anesthesia bill for $4,488. Insurance adjustment and payments leave the patient responsible for $449. Vendor negotiates a 25% discount with savings of $112 • A client incurred $3,300 in uncovered fertility treatments. Vendor secured a savings of $1,155 Negotiated Savings Examples
This product/service is contained in the HR Specialty Products & Services Catalogue™ • Operational level details about this particular service provider can be obtained in conference with the vendor • The HR Mining &Distribution Co. is an independent and contracted representative of the vendor • Upon your request, we will arrange for an introduction that can range from a simple, quick conference call to a services overview / system demo • Tom Ference 219-662-0201 (Chicagoland area) or tference@hrmdco.com • Thank you for your potential interest in this fresh thinking Next Steps
