Why It’s Critical To Have Medical Bills Reviewed

Why It’s Critical To Have Medical Bills Reviewed

It may feel like second nature to review your cell phone, credit card, and internet bill for mistakes. Reviewing your medical bill, however, often feels like a near-impossible task. They are notoriously indecipherable and written with confusing codes, leaving you unsure of what you’re being charged for, how much is due, and where to get help. Even though you’re well aware of today’s inflated medical prices, trying to double-check your bill can be so confusing that it’s easier to pay the charges as long as they’re not grossly unreasonable. By doing so, however, you’re highly likely to be paying for services you never used, visits you never had, and many other flukes. The vast majority of medical bills contain some errors, deeming having medical bills reviewing a necessary step for all patients. Although there hasn’t been a comprehensive study on medical bills, Professor Stephen Parente, of the University of Minnesota has studied medical billing and estimates that 30% to 40% of bills contain errors.

What’s Wrong With Healthcare Billing?

Because of the variation in healthcare coverage between different insurance carriers, there is no such thing as a typical medical bill. For this reason, medical bill errors are not systematic or predictable. They may occur as duplicate charges, charges for canceled procedures, balance billing, and upcoding, where they charge you for a more serious/costly procedure than the one you received. All of these are due to the complex coding system that is used by providers to classify diseases and procedures. This code makes it easy to make mistakes, miscommunicate, and end up inputting a code for a more expensive procedure.

Still, other issues arise from purely administrative errors, like having typos or incorrect patient information or sending the bill to the wrong insurance company. Both can result in insurance companies rejecting the claim, leaving employees with an unaffordable bill. We see these issues every day.

Luckily, there is a foolproof remedy to combat these types of costly mistakes. The easiest way to protect employees and their wallets from inaccurate medical charges are to have a service that reviews and negotiates bills on their behalf. Sure, you can teach employees how to search for billing errors on their own, but the process is so tedious and time-consuming that it would undoubtedly lower their productivity at work. Most people prioritize health and wellness over their job, thus securing employee’s healthcare services and costs is a necessary precursor to maintaining fully engaged workers. There are countless advantages offered by a medical bill review service– ROI and peace of mind are just the beginning.

Negotiating out-of-network fees

It’s a common practice for insurance carriers to perform “backroom deals” with particular doctors and hospitals to negotiate favorable rates in return for directing patients to their services. What results is a configuration of “in-network” and “out-of-network” providers, unique to each insurance carrier. Receiving care from an out-of-network provider comes with costly financial consequences since insurance carriers are trying to make it as hard as possible for patients to leave the network.

If you’ve seen a doctor that happens to be out of your insurer’s network, then you’ll most likely find yourself with a ridiculously steep medical bill. Luckily, the story doesn’t have to end there. Outrageous out-of-network fees can be negotiated down to reasonable levels. Many providers expect that their fees will be discounted and negotiated, so it is up to the consumer and the bill review service to do act on a bill that is higher than expected. Medicare payouts provide a baseline that can be a starting point in negotiations since they are public and widely accepted – even by the provider doing the billing sometimes.

A bill review service can help you do so by making a convincing argument for your case to be paid at an in-network rate. Health plans are open to negotiation, but the reality of this process is that it’s time-consuming and involves phone calls, emails, and letters to be sent back and forth with the carrier. It is much easier to leave this process to a team of experts, who have the experience and know-how that is necessary for working with medical providers and carriers to achieve various discounts and deals within a contract.

Room for Negotiation

An advocacy service can use several strategies to negotiate to pay for out-of-network care at in-network rates. First, they can discuss a patient’s cost-sharing, which includes their deductible and coinsurance rates. Deductibles are usually higher for out-of-network care. Besides, the money you contributed to an in-network deductible may not count towards the out-of-network deductible, meaning you have to start from scratch when purchasing care from an out-of-network provider. Negotiating to pay for care at in-network deductible and coinsurance rates can, therefore, contain costs significantly.

Secondly, they can challenge “balance billing” practices, which many health plan contracts prohibit. Balance billing is when a medical provider bills you for charges that your insurance carrier did not cover. This often occurs because the price for a procedure surpasses what insurance carriers deem reasonable and customary for that given procedure. Because of carriers’ refusal to pay bills exceeding a certain amount, patients end up having to pay a sizeable out-of-pocket bill. Healthcare advocacy services will help patients by re-negotiating what is “reasonable” for the carrier to cover and will work with the care provider to settle on a lower cost for the procedure.

Getting Medical Bills Reviewed is Effortless for Patients

In the smartphone era, saving money through medical bill review is as quick and easy as taking a picture with your phone camera. Fax machines and scanners are unnecessary when you can complete the entire process with your smartphone’s camera and an app.

With medical bill review in today’s world, a patient submits their bill to an advocate immediately after they find a higher than expected medical bill. A medical bill expert will then review the information and set up a consultation with the patient. During this discussion, the concierge will help the user understand the situation and will collect more information from them if necessary. When it appears that a billing error occurred, the concierge begins the negotiation process with providers on the patient’s behalf. They don’t stop until they have a revised bill or a clear explanation of charges. This process may entail calling the carrier, the provider, and the central billing office. Frequently, multiple calls to each of these parties are required, meaning the patient saves hours by entrusting the negotiation process to the support team.

Using a medical bills reviewed is the simplest way to ensure employees aren’t overpaying for medical care. Whereas traditional services will have an employee fax, scan or email a medical bill for review, modern advocacy platforms will make the process quick and easy. Once employees realize how painless the process of lowering their medical bill is, there will be little stopping them from using the service. Finally, medical bill review services will reach out to members and recommend that they consult the service prior to future visits so that they can be steered towards the most cost-effective care decisions and avoid excessive fees. The best way for a patient to make educated care decisions, after all, is to be fully aware of the cost of care before using the service.

Because a medical bill usually brings up more questions than it answers, having an expert advocating on your behalf can be the difference between a bank-breaking fee and a reasonable, predictable expense. Medical billing services at part of a healthcare guidance platform make things simple and easy for members to use.

What Workers Really Want from Employee Benefits

What Workers Really Want from Employee Benefits

If you ask today’s job hunters to describe what they want from employee benefits in three words, they might say; flexibility, mobility, and security. The job market of today is becoming more diverse and increasingly occupied by millennials. The latest wave of employees isn’t satisfied by default, cookie-cutter benefits package that a company has been offering for years. When compared to past decades, job hunters today have a vastly different mindset not only in how they define work but also regarding what they expect from their workplaces. They are prioritizing benefits, wellness, and culture, instead of the than the straightforward and traditional prioritization of income. This is a generation that is ever-so aware that money doesn’t buy happiness. Glassdoor reports 4 in 5 workers prefer more and better employee benefits to a pay raise.

Even as job seekers’ mindsets are shifting, keeping HR on their toes, one thing remains constant: health insurance is the number one most-valued employee benefit. By understanding today’s evolving labor market as well as why health insurance continues to be the most desired benefit, HR strategists will finally be able to design a benefits package for their employees that fits just right. After all, tuning into what employees want from benefits may provide the advantage employers need to win the best talent in the market.

Job Seekers Desire Flexibility and Mobility

By 2020, the bulk of the working population will be millennials and three-quarters of U.S. employees will be part of the mobile workforce. The rise of a digitally connected workforce has led to an increased ability and desire to break out of the traditional 9-to-5 work-day spent in a cubicle. Mobility has led people to champion things like remote work, flexible hours, and paid time off.

Convincingly, the aforementioned Harvard Business School study reveals that the next four priorities on the job seeker’s list following health insurance are more flexible hours, more vacation time, work-from-home options, and unlimited vacation, respectively. It’s noteworthy that 4 of the top 5 most-valued employee benefits all have to do with workplace flexibility.

This desire for flexibility shows that our lives are being reshaped by mobile technology. We store our thoughts, information, and files in the cloud and access them on demand with ease. We feel empowered by the unlimited knowledge available at our fingertips through the Internet. We are the information generation, where knowledge is transmitted with incredible ease and communication happens instantaneously. It only makes sense that workers no longer feel the need to be constantly chained to their office desktops to get their work done. No matter where an employee chooses to work, the gift of flexibility enables them to achieve increased productivity.

Why Health Insurance is Still the Number One Employee Benefit – Security

Despite all the hype about free food, massages, or fitness classes, a Harvard Business Review study finds that health insurance is still the most desirable employee benefit of job seekers today.

This fact should come as no surprise. The rising and unpredictable costs of healthcare make employee health benefits a clear choice and priority. People fear the unknown, and the cost of healthcare is unknown in several ways. Not only is it hard to find the exact prices of healthcare services and treatments, but the state of one’s health, as well as healthcare policy in the U.S., are equally unpredictable. Healthcare affects people’s lives financially, emotionally, and physically, and it is slowly but surely becoming unaffordable to purchase coverage on one’s own. For these reasons, robust healthcare benefits are a priority for job hunters looking for their next employer.

Adding Flexibility and Mobility to Health Benefits

Employees are no longer happy with the typical carriers health benefits experience. Their expectations have changed, they want on-demand help, access to online doctors and all their benefits accessible right from their mobile phone. Companies that add on-demand healthcare guidance are the ones that will win the talent war. With unemployment at historic lows, can your company afford not to provide the best in employee benefits?

How Does Captive Insurance Work and What are the Benefits?

How Does Captive Insurance Work and What are the Benefits?

Common Misconceptions About Captive Insurance

Captive insurance and the way firms advertise it can seem mysterious. In reality, captives are not all that different from self-insuring. By creating and owning its own captive insurance company, any firm can insure the health risks and other unknown expenses of their employees. In doing so, firms reap countless benefits, from greater flexibility in risk management to earning additional income through the savings and interest accrued from the captive. There is a host of misunderstandings that surround captive insurance companies. We’ll look into common false impressions and help you separate reality from myth.  

Are captives only worthwhile for large companies?

Decades ago, the IRS tax code for captive insurance companies, 831(a), was geared towards large corporations with annual premiums over $2.3 million. More recently, however, tax code 831(b) was created to acknowledge the growing middle-market and encourage small and midsize companies to participate in captives. Known as the “micro-captive” tax election, 831(b) is available to businesses that collect $1.2 million or less in underwriting profit. Under this election, insurance companies enjoy a 0% tax rate on their underwriting profits. While historically it might have been the case, it’s no longer true that large corporations are the only ones who can benefit from forming a captive.

With declining capital requirements and operating costs, captives are now accessible to smaller companies. Online platforms enable many companies to get off the ground using limited capital, which frees up potential resources that they can use toward a captive. Given the volatility of a small private company, where a single catastrophe can lead to ruin, and there are no shareholders to fall back on, captives are an excellent way to build up capital and allow business owners to manage their risk.

Nevertheless, it’s always important to make sure captive insurance is a good fit for an individual company. A substantial amount of initial capital is required to ensure financial stability during a crisis and have an adequate amount of reserves available. For this reason, a common practice for small and midsize companies is to band together in a coalition of several employers. By doing so, they can mimic the volume of a large company and engage in risk-sharing while enjoying all the benefits of captive insurance.

Are captive insurance companies main goal to lowering taxes?

Even though much of the discussion on captives is about tax breaks, this legal aspect is just a single piece of the puzzle. Every business owner has their own set of reasons for starting a captive insurance company, and being tax-advantaged is only one of them. Some of the many reasons a company might open a captive are:

Improved risk management: By building up a reserve of cash through a captive, companies can design it to pay whichever costs they desire. No more random fluctuations in the insurance market – with a captive, you get a fully transparent view of your risks and claims, and you decide how best to manage them.

New revenue streams: Not only do you get to see where the money’s going when you have your own captive insurance company, but you also get to recapture the profits that outside insurance carriers would typically enjoy. You even get to keep all of the income accrued from savings and interest, meaning a captive can eventually start making money for a company rather than purely being an expense.

Access to reinsurance markets: While a single captive alone can only provide a limited amount of coverage, it can access the reinsurance market to underwrite its risk. Reinsurance providers offer increased coverage capacity and are less costly than attaining reinsurance through a commercial carrier.

A centralized platform for managing diverse risk operations: a captive can serve as a streamlined information center for managing different risks from various areas of a business. That way, companies can use innovative strategies like transferring risk from one balance sheet to another, which allow them to exert more control over their financial resources.

Coverage for special risks and government programs, such as equipment failure, pollution liability, and terrorism insurance, which are generally unavailable and/or unaffordable in traditional commercial markets.

Do Captives Suffer from Negative PR?

Despite media hype around the captive-related practices of Fortune 500 companies, well-regulated captives are legitimate, compliant insurance companies. While some captives are indeed located in foreign countries like Bermuda and the Cayman Islands, an increasing portion are being established domestically, especially in Vermont, Utah, and Delaware. News outlets often highlight big-name companies who were found to be using offshore accounts as tax shelters, albeit in a lawful manner. It would be misinformed to view captive formation through the lens of big-business financial practices, however. While they offer good fuel for sensationalized headlines, they are not a good representation of a captive’s true purpose.

Captives operate under the Internal Revenue Code sections 831(b), 831(a) and 501(c)(15), allowing their owners to be recognized as U.S. taxpayers. In reality, there is nothing “phony” about a captive insurance company that is formed legitimately under the US tax code. Therefore, the IRS will not crack down on a fully-compliant and well-managed captive unless they find a legitimate reason to hold them accountable.

Captive Myths Busted!

The bottom line on captive insurance is that it gives a business full control, transparency, and profit when it comes to their risk management. They are certainly not exclusive to large firms, solely a tax savings tool, or illegal by any measure.

Captives are pushing companies of all sizes to look inwards and ask themselves, “do you own your risk?” If not, it probably means that a third-party insurance carrier is profiting from it. They empower business owners to control their company risk, instead of paying an insurance firm to do who-knows-what with their premium dollars. Once businesses see their risks and claims as clear as day, they’ll notice the pitfalls in their employee’s spending decisions, such as choosing providers that overcharge them and not “shopping healthcare procedures”. Using a captive means they will have the information and flexibility to do something about it. They can nudge employees to better care options, and pinpoint areas for improvement.

At the end of the day, it’s a story about incentives. Large insurance carriers have an incentive to increase premiums and earn profits in the process. Your business, however, has the incentive to control costs and help your employees make better healthcare decisions for their health and finances. Now, no misconceptions will stop you from doing what’s right for your company.


Want to learn more? Watch a great video by Andrew Clayton, President – Pareto Captive Services at Cypress U

Ensuring Your Security and Privacy Within HealthJoy

Ensuring Your Security and Privacy Within HealthJoy

At HealthJoy, we believe that privacy is your fundamental right. We design every technical system, process, service from the ground up to protect your information. We understand that your healthcare data is the most personal information possible and take extreme care when working with it. We never share a member’s data with their employer, spouse or any other 3rd party without consent. We are 100 percent compliant with all federal privacy laws as well as the Health Insurance Portability and Accountability Act (HIPAA) which has strict guidelines on how to handle data. 

Only You Can Access Your HealthJoy Account

You can secure your HealthJoy account easily with a password that meets password best practices in use today- i.e. at least eight characters long that contains digits, alphanumeric and standard characters. You can create millions of possible combinations. You can also use advanced security technologies such as Touch ID or Face ID to log into your account.

Your Healthcare Data Belongs To You

We understand that when it comes to your health and health records, these are private matters. We will never share your data with your employer, under any circumstance. The only data we may share with an employer is aggregated data that’s 100 percent anonymous to protect privacy. An employer will never see your health record. All aggregated data presented is based on the entire employee population, so your employer might view how many online medical consultations happened in April for the whole company, but they will never know you performed five for your family that month. HealthJoy doesn’t gather personal information to sell to advertisers or other organizations.

Fort Knox Approach To Data

We are serious about cybersecurity, our data and how the handling of that data complies with all HIPAA federal requirements and we take it much further. We only use 256-bit encryption within our app and to store all data. Our data center is SOC2 compliant. SOC2 is an auditing procedure that ensures your data is securely managed and processed.

Robust Employee Training

Our employees provide you and your family with confidential, one-on-one help in navigating the complex healthcare system. They are trained to work with providers, facilities, insurance companies, and other health-related organizations to resolve complex issues. They also go through extensive training on HIPAA and how to handle any data. If at any point they need to work with a 3rd party on your behalf with sensitive information, they will get your approval and will not proceed without it. Every one of our employees understands the trust our members place in us each day.

Your Transactions Are Safe

Your peace of mind is our highest priority. Our app connects with 3rd party financial accounts including 401k, HSA, FSA, HRA and many more.  We’re serious about security and use cutting-edge technology to ensure your personal information is fully encrypted and securely stored. For members with high deductible health plans that have a medical consultation fee, we utilize Stripe.com, a PCI Service Provider Level 1, that manages billions of dollars every year in transactions for the largest companies in the world. Our company never stores your financial information on our servers.

Only The Best Partners In The Business

Your mother was right, people judge by who you associate with, and we take that to heart. We only work with companies that are entirely HIPAA compliant that handle your data with care. We make sure through both process and technology that we treat all information correctly. We require HIPAA business associate agreements (BAA) in place with each of our partners to maintain PHI security and overall HIPAA compliance

4 Tips to Maximize Utilization When Launching New HR Initiative

4 Tips to Maximize Utilization When Launching New HR Initiative

You’re about to launch an exciting new HR initiative, and everything’s in place to ensure it’s a smash hit. Everything except your employees that is.

As an HR leader, launching a new program feels like a complicated juggling act. You face budgetary concerns, culture-fit, and buy-in from upper-level management, not to mention your list of already existing tasks. Once the program is finally ready to launch, you might be tempted to breathe a sigh of relief, sit back, and watch the program work its magic.

Long-term program success doesn’t happen with the flip of a switch, however. Merely having a value-adding program is not enough. For the program to make a real difference, it must achieve a high utilization rate by your employees.

A new HR initiative is useless if it’s underutilized. No matter how fired-up you may be about the program’s value-add for the company, it’s crucial that your employees feel the same way. Here are five simple, yet essential steps to winning higher employee utilization when launching a new HR program:

Spread the word

First and foremost, clear communication of your program to employees is the foundation of a successful rollout. During a new program launch, HR departments should proactively communicate with and rally employees at three key touch points:

  • Preliminary communication: Before you reach the rollout stage, start generating buzz for your program internally. Send out an email giving sneak peeks that highlight some of the coolest features of the program. It may also be helpful to reach out to the program vendor to get tips on how to build excitement for the launch based on past rollout experiences at other companies.
  • Communication during rollout: The rollout period should be informative and appropriate. Don’t assume bigger is better — depending on your organization, intimate small group meetings may be more appealing to employees than bigger lecture-style presentation.
  • Follow-up/after rollout: Continual communication post-launch is essential to integrate a new program into your company culture permanently. Make sure to maintain follow-up communication in a frequent yet focused manner, so that employees aren’t overburdened with information. It’s important to repeat, repeat, repeat– even if employees don’t hear you the first time, they’ll remember where to go when the time comes.

When communicating with employees, consider “The rule of seven” from marketing. This is an old but relevant concept that says that someone needs to hear or see a message over seven times before it enters their consciousness. You can’t expect to fire off a single email and have it work for you — it’s always better to over-communicate.

Educate your employees

Once employees are aware that the program exists, they need to know how to take advantage of it so that it can enhance their lives. Awareness and education sessions can be leveraged to dive deeper into the features and functionalities of a new program, especially if it has an app or tech-based component.

While it may be easier to put employee education on autopilot, any effort will be more rewarding if it is well-suited to your workplace culture. Try to think outside the box– instead of sending emails, take advantage of new media platforms or create engaging visuals to display throughout the workplace. The best clues are found just by knowing your employees– if no one reads the company newsletter, then perhaps a different medium, such as an informal get-together, might be a more effective setting for coaching employees.

Overall, education will help employees understand the true value of the benefits they are receiving. Once they know exactly what they have and how it works, they’ll be quick to realize what it’s worth, which will drive up utilization rates naturally.

Designate internal champions for your HR initiative

Sometimes people will only listen to you if you know what it’s like to be in their shoes. Relatability is a key factor in getting people’s attention, establishing credibility, and building trust. Thus, with any new program or initiative, sharing examples of employee success that people can relate to is invaluable.

One great way to go about this is by designating an internal champion who is devoted to the program and truly believes in its value. When a single person is passionate about a program, they have the potential to inspire many others to jump on the bandwagon.

For example, take a story we heard from one woman who saved her husband’s life using the HealthJoy app. Her husband never sees a doctor and doesn’t use medical care. One day, they were driving home from vacation when the husband said he wasn’t feeling well. The woman insisted they needed to go to a hospital, but her husband refused, saying he just needed to lie down. The woman said, “I have this app on my phone. We can talk to a doctor in 10 minutes, and if they say you need to go to the hospital then we are going. Deal?” He agreed, and they used the app to do a telemedicine consult. The doctor said he needed to go to the hospital, and it turns out he was having a heart attack. When they arrived, they told them if they had delayed in going to the hospital, he might have died.

Sharing this type of success story, especially when it comes from employees themselves, is one of the most effective ways to get people moving and convinced about a program’s value. Don’t be afraid to champion an employee and let them lead from within– their genuine support of the program may be enough to convince the entire workforce.

The right incentives matter

Employees often need an extra push to engage with a new HR initiative and see for themselves why it works. Incentives are financial rewards for successfully exhibiting a behavior. Depending on your program, different approaches can lead to equally fruitful employee participation.

Sometimes it works well to provide small incentives to randomly selected employees who successfully complete a desired behavior. By giving people the chance to win (rather than a guarantee), you can create strong motivation without producing entitlement. These incentives can take the form of raffles for gift cards, prizes, tickets to events, and more. Other times, more significant incentives are needed when the behavior is hard to achieve or if the reward to the company is greater. For example, having an employee go to a local MRI provider whose fee is $500 vs. going to a hospital for the same procedure with a fee of $10,000 might require a more significant incentive, but the payoff is also greater.

To drive utilization, you need to choose the right incentives. In other words, the target behaviors being rewarded must motivate employees to engage with the program and experience its benefits firsthand. For instance, the right incentive for a 100-day step challenge shouldn’t be for employees who merely sign up for the program, but rather those who meet their weekly step goal.

Lastly, make sure that employees are aware of the full value of the financial benefits they can receive by participating. A 2017 UnitedHealthcare wellness study finds that 64% of surveyed employees underestimate the financial value of wellness program-related incentives. When they understand the full extent of financial benefit from using a program, employees will undoubtedly be driven to participate at higher rates.

Launching a new HR initiative is stressful and tedious, so you need to guarantee that your diligent efforts pay off in the form of high employee participation rates. From employee benefits to compensation to performance management, attracting high employee utilization is key to the success of any new HR initiative launch. Follow these steps, and you’ll find that all the hours spent convincing the C-suite to support your spectacular new program were completely worthwhile.