MEDICAL EXPENSE PROCESSING
- How can consumers be sure to get the full benefit of their health plan's negotiated provider discounts?
- How can the processing of under- and over-payments to providers be made more efficient to offset the lower premiums paid by employers for high deductible health care?
- What happens when medical expenses exceed available HSA balances?
Challenge:
How can consumers be sure to get the full benefit of their health plan's negotiated provider discounts?
RECONCILER™ Solution:
With current HSA technology, debit cards presented to the service provider at the time of service are of limited value because the discounted or "re-priced" bill amounts are not available until sometime later, when the health plan actually processes the claim.
Often, when used at the point of sale, providers confuse the debit card with a retail cash transaction that is not related to their negotiated network discounts. This makes it less tha certain that a consumer will receive the proper refund for the network savings.
The final straw occurs when the consumer finds out that the health plan/TPA has only applied the discounted amount to their deductible—when they paid full price for services. This can be frustrating for consumers who quickly become disillusioned with their cumbersome new health plan.
RECONCILER helps the consumer track network savings by displaying the actual amount of the discount negotiated by the health plan. This enables consumers to monitor provider discounts and see exactly how much of their payment was applied to the deductible.
Using RECONCILER, consumers can quickly follow up with providers who made processing errors or when refunds are due.
RECONCILER will be further enhanced to link electronically to Point of Sale service providers and calculate the discounted charges at the point of service—helping consumers avoid overpayment altogether.
Challenge:
How can the processing of under- and over-payments to providers be made more efficient to offset the lower premiums paid by employers for high deductible health care?
RECONCILER™ Solution:
Without a link or cross-reference between the health plan/TPA systems and the financial systems, all corrections for under and overpayments have to be accomplished manually. This requires quite a bit of extra work on the part of the health plan/TPA. At minimum, it involves phone calls and manual check writing. And often the consumer is forced to get involved.
Even after all of the money is manually repaid to the appropriate party, the work is not done. At that point, the health plan/TPA must somehow get the bank to appropriately record the changed transaction in the consumer's HSA.
Electronic provider adjustments can be made quickly and easily through RECONCILER. This eliminates the expense of manual processing and check writing and speeds up the transfer of dollars to or from the consumer's HSA.
Best of all, RECONCILER serves as the intermediary between the health plan/TPA and the bank, even allowing direct email communication between all parties.
RECONCILER reduces the costly and time consuming processing of under and overpayments while promoting open communication and responsiveness between all parties.
Challenge:
What happens when medical expenses exceed available HSA balances?
RECONCILER™ Solution:
One of the ways that HSAs differ from HRAs is that the employer's contributions to the fund immediately become the property of the employee. Treasury rulings reaffirm that the employer has no control over the way employees spend this money.
Consequently, to mitigate risk and protect their own cash flow, most employers make monthly contributions equal to 1/12th of the amount of the annual fund.
Because the fund will have relatively low balances at first, consumers may receive billed charges in excess of the HSA balance. This shortfall can put considerable strain on the relationships between health plans/TPAs and provider networks who have previously looked to the health plan/TPA as a source of guaranteed payment.
RECONCILER offers health plan consumers a line of credit tied to their HSA account. Borrowed amounts are deposited directly in the account, which the holder can then use to make qualified medical purchases on an after-tax basis.
RECONCILER helps consumers keep track of these credit draws and enables them to direct repayments to their credit line once their HSA is adequately funded.
In addition, to avoid this situation altogether, RECONCILER provides the consumer with the ability to utilize accounts other than their HSA to electronically fund any shortfall.
Questions?
To discuss how we can help your organization, please contact us:
or
(949) 756-0037
