Health insurance carriers contract with various physicians, hospitals and other providers to attract customers. Larger networks help insurance carriers to sell their products and plans. Frequently the relationship between these network providers can supersede that of the employer group. Take the example of the bill listed below:
The highlighted sections were reviewed because of the charges. The patient was billed for 16 Anchor/Screws. Upon further review, it was discovered that only 6 screws were actually used. When an audit of the claim was done, the insurance carrier responded.
“Your audit of the provider bills have caused significant strain on our network providers. Cease and deceits from auditing the bills from our network providers and pay the claim as billed.”
Who really is the customer here?
There are ways to align the providers, brokers and hospitals in order to accomplish lower claims, and healthier employees all at better rates.
