Unchecked out-of-network (OON) charges can result in high surprise bills for patients and high costs for payers. One reason: The cost for out-of-network care is often well above national averages and norms. It’s crucial for payers to protect their members from larger deductibles and out-of-pocket limits by minimizing the risk associated with OON care. And in doing so, payers can also improve employer savings, administrative and medical cost savings, and appeals processes.
On today’s show, Mary Canobbio interviews Anna Bash, claims manager at third-party administrator Employee Plans, and discusses how a claims repricing network can help reduce excessive expenses and protect members by discounting OON claims in collaboration with providers.
Here’s what they dug into:
- The impact of political instability on the healthcare market (02:27)
- How a small percentage of OON claims can lead to increased premiums (03:49)
- Generating savings through OON risk mitigation (05:56)
- The impact of OON claims on members and their employers (07:14)
- How direct negotiation with non-contracted providers offers payers a safety net (09:30)
- Removing the threat of balance billing for members (10:07)
- Why member savings are greater than the distributed cost of repricing (10:41)
- How contractual compliance with coding standards can drive payer savings (11:41)
- Exploring fair market pricing as a network alternative (12:47)
- A recent JAMA article identified six domains of healthcare that are responsible for $935 billion in wasted healthcare spend annually: