HHC Group works to ensure providers understand and accept
the reimbursement they receive on behalf of our clients who use reference-based pricing and to protect clients' plan members from balance billing.
However, in some cases providers may question their reimbursement. Fortunately, HHC Group can help with our Provider Appeals Support Program that includes a full continuum of support services included in our reference-based pricing fees:
- We provide the client's plan document and the pay rate enumerated in the plan document.
- We negotiate with providers that are unwilling to accept the reference-based pricing amount as payment in full. In most instances, reference-based plans include an allowable, higher multiple than the standard multiple. HHC seeks to settle the claim without exceeding this higher multiple amount.
- When we are able to secure agreement within the higher multiple, with the Group's permission we will attempt to negotiate an acceptable settlement.
- We reprice claims based on HHC Group's negotiated provider network rates (if the specific provider is part of one of these networks).
In the rare case that an acceptable settlement cannot be reached through the above methods, HHC Group has an outside legal team that specializes in reaching an amicable disposition of each claim.