Health Care Costs

Contracted Discounts Don’t Always Equate to Fair Payments

Contracted discounts don’t always equate to fair payments. Our medical bill review service provides a defensible means to fair charges.

Payors of medical claims are, of course, accustomed to paying their bills according to the rates or percent discount set forth in the contracts with facilities.  But with the rapid rise in hospital charges seen over the last five years or more, how does the payor KNOW the negotiated discount is a fair rate today?

Hospital charges have recently risen at such an incredible rate that a 10% discount offered in the 70’s would require an adjustment of approximately 76% to equal a 10% discount today.

Marc Chapman of Chapman Consulting believes you cannot measure your success by the discount percentage.  He stated “For example if we get a claim from Johns Hopkins, I know that discount will not be a large number. Their charges are not as over inflated as other providers in the country.  This is why in some case we may be satisfied with a 20% discount with one claim, but are demanding an 80% discount from a claim in Florida that charges $5,000 for a CAT scan.”

As prices have escalated more payors are questioning the fairness of what they are expected to pay on these claims and searching for a solution. Many times the claims end up in litigation in an attempt to resolve the issue.  The high dollar claims naturally garner a lot of attention due to the sheer size of the expected payment, but a large volume of smaller claims unfairly paid at too high of a rate certainly adds up too and can make an impact on your bottom line.

At Chapman Consulting we are contacted daily by attorneys and payors searching for a valid, defensible approach that will result in a fair payment in today’s marketplace.

We can assist with any high dollar insurance claim where the payor is frustrated with the inadequacy of the contracted discount and is insistent on a fair price for the services rendered.  Larger medical claims including Workers’ Compensation and Texas Non-Subscription, which is an alternative to Work Comp in Texas, many times have the potential for us to negotiate much fairer pricing.

Unsure if we can help?  Send us the claim.  If we cannot help you we will let you know and at no charge.  We work hard to get the fairest reduction possible for all of our clients in the fairest way possible!