News
In a recent article published by one of the world's largest re-insurance companies the following excerpt authored by Dr. Colin Plotkin appears. As a vendor who continues to work on behalf of several major clients to achieve results better than the standard PPO discounts, Dr. Colin Plotkin has been able to achieve remarkable settlements that are accepted by both providers and insurers.
According to Dr. Colin Plotkin of Dr Plotkin Consulting, hospitals can charge "what they want" There is no regulation regarding the cost-to-charge ratio from a hospital provider as long as there is no parallel billing
and a single "exit price" is practiced. In other words, the original billed amount has to be the same for everyone, insured, uninsured, Medicare, Private Insurer, and the like. The difference comes in how much a hospital provider is willing to discount a bill, and depends on who the payor is, with Medicare recipients getting the most favorable rates.
Dr Plotkin goes on to say that it is becoming more common to negotiate individually on catastrophic claims in order to mitigate the significant losses to insurers. Normal, run-of-the-mill, volume-based claims fall under provider contracts. Negotiating behind these contracts, to obtain larger discounts on catastrophic claims is often frowned upon by providers who might argue that that if satisfaction occurred with a level of discount on smaller claims, why are those same discounts unpalatable on the larger cases? It behooves insurers to put wording into provider contracts that will permit them to negotiate large catastrophic cases. To achieve success and favorable loss-ratio, it is important to use experts in traversing this mine field, negotiators who are well versed in the cost-to-charge ratios of hospitals, average costs, insurance knowledge, medical expertise, legal knowledge, economics, and a host of other modalities. Attempting to negotiate the increasingly common million dollar claim, is not for the rookie negotiator, or the faint of heart.
| Date | Article Name | Download |
|---|---|---|
| 2009 Summer | Distrust Deepening Between International Insurers and U.S. Providers | |
| 2008 October | Cost Containment: Working Together I | |
| 2008 September | Cost Containment: Trends in "Reasonable and Customary" and "Non-Par" Claims | |
| 2007 December | Cost Containment: Volatile, Misunderstood, No Easy Task | |
| 2007 March | Cost Containment - what's all the hype about? |
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