Data Mining

Ever wonder how your health claims compare to the market? How do you know you are paying a fair price? Or do you look at your claim runs with the assurance your TPA and managed care company are giving you the best in health care finances? Have you ever checked? Why not? It might be informative if you did.

Take for example a case we looked at today. All in-patient hospital claims for the past 12 months were reviewed  through a comparative analysis using multiple PPO contracts, Medicare and Medicaid benchmark data.

How do the claims look? How much would have Medicare or Medicaid paid? What did a sample of PPO contracts allow? How did the PPO allowable compare to benchmarks used? Could the client have done better than actual paid claims? If so, how much could have been saved?This exercise should be par for the course for ERISA plans. It is much like interviewing departing passengers from a flight; Sir, how much was your ticket? As is true with health care, not all passengers pay the same. But, would it not be useful to have this information? It might be helpful in  knowing what prices to pay for the best deal.

Editor’s Note: Joining the 50% Club is always an option  –