Overtreatment of Lower Back Pain Costing Billions
An estimated $86 billion dollars is spent on the treatment and management of
lower back pain in the U.S. annually. According to a Health Affairs blog, much of that
money is wasted or worse, being spent providing health care services for which the
potential harm outweighs the potential benefits. The contributors to the wasted
billions and harmful overuse are many and the costs continue to skyrocket.
Doctors, Hospitals Wage War on Price Transparency
The battle over price transparency is being fought in states throughout the U.S.
Ohio's Healthcare Price Transparency Law mandates that providers must give patients
a "good faith" estimate of the cost of non-emergency services before they start
treatment. The law was scheduled to go into force on January 1 of this year. However,
due to legal challenges from the Ohio Hospital Association and a wide range of
providers, the law has never gone into effect.
Provider-Sponsored Plans Finding Tough Sledding
Health systems are finding that the healthcare insurance business is not as easy as
it looks. Many systems that started their own health plans find themselves bleeding
red ink. Some, like Catholic Health Initiatives of Englewood, Colorado and Tenet and
Tenet Healthcare had gotten out of the business altogether. Others, like Northwell
and CareConnect are retooling their business plans with the hopes of stemming
their losses and staying in the business for the long hall.
When Providers Balk, Our Bulldogs Bark
More and more employers with self-funded health plans are turning to
reference-based pricing to reduce their overall spend. They like the deep savings
and they appreciate the price predictability regardless of which provider the
plan member uses.
Of course, some providers may balk at the reimbursement amount even with a
clear Explanation of Payment (EOP).
That's okay, because HHC Group's bulldogs will bark when they balk.
For all our plans that utilize reference-based pricing services we're available to address provider appeals – from explanation of payment to direct negotiation. And we support these types of appeals whether we reprice all your client's claims, only hospital claims, only physician claims, out-of-network claims, or specialty services claims.
and see how we bark back at providers who refuse referencebased pricing.
Or reach us directly at 301.963.0762 ext. 163 or by emailing email@example.com
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