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 October 2007
Persistence
Clients frequently ask us how we are so successful at recovering managed care underpayments on their behalf- especially when their hospital already has a recovery unit in place. The first part of the answer is that our unique line-by-line methodology identifies underpayments that systems and other vendors frequently miss. The second part of the answer is Persistence.
Health Check deals exclusively with difficult claims. Many of the accounts we are pursing are older, are complicated, and many have already been denied at least once. This is the world that our Revenue Recovery Representatives live in, and they are very well adapted. They ensure that our clients are paid appropriately on each claim by taking taking a systematic and detailed approach to each account and then aggressively yet professionally seeking additional payment from the insurance company. They make regular phone calls, write detailed appeals, and submit nurse-written medical appeals.
Over time, our team has adopted a quote from Calvin Coolidge, the 30th President of the United States, as their motto. The quote, found below, can be found posted throughout our offices and truly represents the approach we take for our clients every day.
"Nothing in the world can take the place of Persistence.
Talent will not; nothing is more common than unsuccessful men with talent.
Genius will not; unrewarded genius is almost a proverb.
Education will not; the world is full of educated derelicts.
Persistence and determination alone are omnipotent.
The slogan 'Press On' has solved and always will solve the problems of the human race."
Limited Benefit Plans Offer Limited Payments
The allegations, evidence, and lawsuits are mounting nationwide against insurance giant HealthMarkets and its subsidiaries Mega Life and Health Insurance and Mid-West National Life Insurance. A recent case, filed by Massachusetts Attorney General Martha Coakley, alleges the companies of deceptive sales and marketing practices, as well as improper denial of claims. HealthMarkets, which insures over 500,000 members in 44 states, is also fighting cases brought on by claimants nationwide and preparing responses to state insurance regulators' questions as well.
USA Today reports that the company's subsidiaries combine for an average of twice the number of member complaints compared to other insurers throughout the country. The limited benefit policies are marketed to individuals with no access to group insurance, and offer premiums that are affordable for what appears to be legitimate insurance coverage. The majority of plans carry a low maximum payment for both inpatient and outpatient services, forcing the patient to shoulder the majority of the responsibility for payment for medical services. These patients, who were under the impression that the majority of their incurred expenses would be covered by their policy, are often shocked upon receipt of their bills.
The Georgetown University Health Policy Institute is awaiting results from various state probes to issue their final opinion on the matter. Preceding these results, Georgetown did, according to the school's website, switch companies for their uninsured student population from Mega Life to United Healthcare, effective for the 2007 - 2008 school year.
What do these, and other similar policies issued by United Healthcare's student insurance, Cigna's limited plans, Aetna's Chickering plans and others, mean to a facility's bottom line? While studies have yet to be conducted, these limited benefit plans will undoubtedly mean an increase in charity care and bad debt to any healthcare organization at which the plans are presented. Patients present under the impression that they are covered by a thorough medical policy, only to find out services are capped at unreasonably low maximums, and that the policies offer no maximum out of pocket expenses.
Upon presentation of one of these policies, Admissions employees must ensure that their benefit and authorization calls are thorough and include not only the co-pay and co-insurance, but the maximum benefit for overnight accommodations, laboratory work, etc. per "sickness incident." This will allow the facility to notify patients upfront, especially on elective procedures, of the costs they are likely to incur. Perhaps with this knowledge on hand the patients can become more educated and highly prepared healthcare consumers.
For more information on limited benefit plans and how to identify them, please contact Health Check Incorporated's Research Department at 1.800.633.2055.
Health Check Office to Relocate November 1st
Health Check is pleased to announce the relocation and expansion of our South Florida office in Hollywood, Florida. The new office is located at 2500 Hollywood Boulevard, just steps from our old office. Other contact information will remain unchanged.
This new office will allow Health Check to more than double its staff in this office and to add an auditing and recovery team to better serve our clients.
Health Check to further increase HIPAA Security
 Health Check has contracted with Speech Privacy Systems of Plano, Texas to install their patented Voice Arrest speech privacy/sound masking system in Health Check's main office in Mexico Beach, Florida.
This new system will build upon Health Check's existing industry-leading HIPAA privacy and security systems, and further ensure that our clients' data and information is treated with the highest possible security.
For more information about this system, or Health Check's other HIPAA privacy and security measures, please contact Chuck Edwards, Senior Vice President, in our Mexico Beach office at 1.800.633.2055.
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