Members decide between Free Care vs Not-So-Free Care at the Point of Service…………………….
By Bill Rusteberg
Self-funded health plans adding a cash pay plan option will achieve lower costs while increasing benefits at the same time without interfering with existing relationships.
The Concept is Simple
Self-funded plans have established a pot of money from which to pay claims. Dollars flow out through managed care contracts negotiated by third party intermediaries.
The process creates an administrative burden with associated expenses. There is always a delay in payment that can take weeks and months.
Due to traditional benefit structures with deductibles and co-insurance features, doctors and hospitals are constantly chasing patient share.
Hospitals in particular have difficulty collecting from patients strapped for money, with hospital account receivables averaging 18-22%. In many instances patient balances are written off as a loss. These losses are factored in when providers negotiate their provider agreements every year, effectively ramping up reimbursement rates to recoup unpaid patient balances.
There is a better way to pay for health care. And it’s much less expensive.
The Solution
Health care givers are paid in cash at the point of service. Providers are paid in full – no balance billing issues, no claims to file, no deductibles, no co-pays, no patient responsibility to chase. Cash monies funded by the plan sponsor are transferred electronically and instantly deposited to the benefit of the provider on the same day services are rendered.
Instead of claim dollars allocated through managed care contracts, the same monies from the same claim pot are reallocated as cash payment direct to providers. This effectively leverages claim dollars by as much as 5 to 1 or more.
Everyone wins. Providers get paid quickly, fairly and transparently on the day of service. They are not required to file claims or chase patient share.
Patients get the care they need when they need it without facing crippling financial barriers to care that often times effectively bars access to health care.
Plan sponsors win too by saving money and providing plan members with a better health care experience.
Easy To Implement
This strategy can be offered as an option to any existing plan. Plan sponsors keep the same plan they have always had including their trusted broker, a politically easy move to better health care.
This stand alone benefit provides members a choice between free health care or not so free health care at the point of service.
Members who choose not to use this plan option will continue of enjoy the same benefits (Really?) they have through their existing employer health plan.
Summary
Advantages to Plan Members
- All financial barriers to health care are eliminated
- Improved patient experience
- Never a balance bill
- Concierge service sets appointments, identifies high quality providers
Advantage to Plan
- Savings up to 50% and more
- Reduces retail claim dollars to wholesale cash price claim dollars
- No additional cost to the plan, current funding does not increase
- Provides plan members more choice and the freedom to choose
Advantage to Community Health Care Providers
- Payment in full at the time of service
- No chasing of patient financial responsibility
- No claims to file
- Elimination of third party intermediaries – restores patient / physician relationship
Members decide between Free Care vs Not-So-Free Care at the Point of Service
There is no reason why a plan shouldn’t do this. It’s possible and it’s been done with good success. We know how and you should too.
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
