http://www.preceptgroup.com/blog/2008/hospitals-need-to-go-green/?utm_source=rss&utm_medium=rss&utm_campaign=hospitals-need-to-go-green An insider's perspective on employee benefit programs and the issues that affect employers most. Sun, 01 Aug 2010 12:03:04 -0700 http://wordpress.org/?v=2.8.4 hourly 1 http://www.preceptgroup.com/blog/2008/hospitals-need-to-go-green/#comment-36 Mari McCully Fri, 12 Jun 2009 00:00:00 +0000 http://webdev.preceptgroup.com/blog/?p=2638#comment-36 Hospitals are required by law to provide you with an itemized statement which reflects their usual and customary charges (called a Charge Master) for each service and supply billed. The "re-pricers" make recommendations to your insurance company as to what it should reimburse after "bundles charges," denies some charges in their entirely, and "re-prices" charges that it decides to reimburse based on the re-pricer's determination of "usual and customary and reasonable." What the re-pricers don't want you to know, is that the "data" that they use is unaudited, flawed, and unfairly biased in the insurer (and the re-pricer's) favor, because the re-pricer is typically reimbursed a percentage of the amount it discounted from the hospital's bill. Even if the insurance company ultimately reimburses the hospital (this happens with individual heatlh care providers, as well) an amount that is in accordance with your insurance policy, or its "network" agreement, if any, with the hospital, by using these "re-pricer" strategies they are unfairly delaying payment, and gaining an unfair benefit through the time value of money. There is a substantial amount of litigation currently pending regarding this issue, including the Attorney General of New York against a company called Ingenix and its corporate parent. Hospitals are required by law to provide you with an itemized statement which reflects their usual and customary charges (called a Charge Master) for each service and supply billed. The “re-pricers” make recommendations to your insurance company as to what it should reimburse after “bundles charges,” denies some charges in their entirely, and “re-prices” charges that it decides to reimburse based on the re-pricer’s determination of “usual and customary and reasonable.” What the re-pricers don’t want you to know, is that the “data” that they use is unaudited, flawed, and unfairly biased in the insurer (and the re-pricer’s) favor, because the re-pricer is typically reimbursed a percentage of the amount it discounted from the hospital’s bill. Even if the insurance company ultimately reimburses the hospital (this happens with individual heatlh care providers, as well) an amount that is in accordance with your insurance policy, or its “network” agreement, if any, with the hospital, by using these “re-pricer” strategies they are unfairly delaying payment, and gaining an unfair benefit through the time value of money. There is a substantial amount of litigation currently pending regarding this issue, including the Attorney General of New York against a company called Ingenix and its corporate parent.

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