Help With Low Paid / No Paid Insurance Claims For Out of Network Billing
A few words about our process
As an out-of-network health services provider you know that getting paid by insurance companies isn’t always easy, fast or for the amount billed. Insurance verification of benefits (VOB) is usually one of the first steps in a sometimes, complex financial decision matrix intrinsic to the admissions process. But can you rely on the VOB to assure adequate payment for services rendered? Have you ever received less money than what the VOB indicated?
Below is an out-of-network example of a typical billing cycle for a single patient’s total billing for services rendered:
Admission – VOB
- Medical necessity.
- Unlimited benefits.
- Pays at 60% of usual-and-customary billing (UNC) until deductible and out-of-pocket have been met. Then 100% payout.
- $5,000 deductible.
- $12,000 out-of-pocket etc.
Billing – Claim
- Submitted claims total $70,000 (Minus $12,000 deductible & max out of pocket) $58,000 owed.
- Deductible and out-of-pocket have been met.
- Receive payment after 45 days.
Payment – EOB
- Insurance company “Allowed Rate” total for all claims $11,040.
- Payment amount is $12,600.
- $45,400 still outstanding.
- Payment is approximately 18% of billed amount.
- Claims re-submitted for processing to reclaim deficiency (14 Days).
- 1st appeal (30 Days).
- 2nd appeal plus notification to State Insurance Commissioner (30 Days).
- Insurance company final denial.
- ClaimPath locates all of the low paid claims.
- No upfront fees to the treatment center.
- Estimated increase in payment of additional $22,400.
- 50% of the additional payment goes to the center.
The above outline concludes with the following collection payout to the provider:
– Provider receives: $11,200 (88.8% more collected!)
ClaimPath, in this example, increases the center’s collection percentage significantly. This type of cash flow increase can mean the difference between surviving and thriving as a business. The benefit ClaimPath offers is extremely valuable to any healthcare provider seeking to improve cash flow.