There Is No Such Thing As A $1,000,000 Health Insurance Claim

amolly

 

Ever buy Alien Abduction insurance? It’s pretty cheap. How about UFO Kidnapping Insurance? That’s just about as cheap as an Alien Abduction insurance policy. And what about coverage for $1 million health care claims? That’s dog-gone cheap too. In fact, less than $1 per month. A careful analysis of one’s monthly budget might bring a reasonably prudent person to  a crystal clear  conclusion that $1 may be better spent on Alien Abduction Insurance. At least that would allow you to stand out at social gatherings,  giving you bragging rights with added confidence, breathlessly passing subtle comments  to the redhead in the corner like “I used to have  a $1 million health insurance policy but I switched to a $1 million Alien Abduction Insurance  plan instead and since then I have felt so much more secure!”

On the other hand, coverage for a $50,000 health insurance policy can be pricey.

 

Cost Plus Methodologies Achieving True Cost Containment

payerfusion

 

Discount vs. Cost-Plus

From a financial perspective, the discount model employed by PPO’s is ineffective because a discount based on an inflated price does not provide effective cost containment. It is not anchored to the real cost of care. Rather, this outdated approach encourages gaming of the system as providers seize the opportunity to raise their prices disproportionately to their true costs in order to increase their “discount.” However, true cost containment is reached when our cost-plus methodology is used. Once we  have a claim clean of errors and fraudulent charges, we assess the actual cost of the care provided, and then reprice the claim to acomodate the cost, plus a reasonably negotiated fee.

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