Archive for January 30th, 2014

United Claims Solutions

Thursday, January 30th, 2014

united

Medicare Plus Repricing

UCS has developed an innovative solution that offers an alternative to PPOs by applying Medicare Plus reimbursement to facility, physician and ancillary providers in lieu of traditional PPO discounts. The result is significantly reduced plan costs and lower stop-loss premiums. 

  • We offer a Hybrid model that utilizes PPOs for physician services and Medicare Plus pricing for facility charges
  • Medicare Plus can also be used to discount out-of-network medical bills
  • Programs range from basic repricing services, to full patient advocacy and legal intervention

For more information, visit www.unitedclaimsolutions.com

Editor’s Note:  Cost Plus, Medicare Based Reimbursement, Reference Based Pricing models are quickly replacing PPO networks in the United States. In response, PPO networks are offering “narrow networks” comprised of providers who charge less than others in their overall network.

Under ACA, the only way for TPA’s and carriers can compete is through provider reimbursement strategies. Since health plans are now limited to Bronze, Silver and Gold plans, little can be done to compete based on benefits alone. Cost shifting, in the traditional sense, is forever changed, especially for grandfathered plans.

More are beginning to understand that health care costs are a direct function of what we agree to pay.

Alan Cohen’s Crazy Idea

Thursday, January 30th, 2014

Liazon’s Alan Cohen. (Photo by David Johnson)

Six years ago, Alan Cohen had a crazy idea. The idea was simple, yet powerful: Let employees choose the health insurance plan they want, rather than having their employer do it for them. It would be done by allowing workers a fixed amount of money from their employer to spend in an online marketplace where they could purchase an array of benefits.

(more…)