Andy NearyI help insurance professionals turn brand awareness into business growth.

SOTSQ Episode 12 - The Auto Adjudication of Medical Claims is Eating Away Your Bottom Line

9 Aug 2018 · 1 min

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1:08

Andy Neary explains that a high percentage of auto adjudication in medical-claims processing creates hidden waste for employers. Using a restaurant-bill analogy, he shows how automated reimbursement can pay inflated or inappropriate line items (chef, expediter, waiter, restaurant fees), increasing plan costs. He urges plan sponsors to ask brokers/carrier reps about the insurer's price point for running claims, request itemized bills (higher-dollar claims often contain more waste), and contact him with questions.

Chapters

Have you ever been told by your broker or your insurance carrier rep that the high percentage of auto adjudication of the claims inside your medical plan is a good thing? Well, it's not. Let me explain. Imagine one of your sales reps takes out a client for a steak dinner, and the next morning she submits the bill for reimbursement. And your finance team auto reimburses her the money without even looking at the bill. And then you take a look at the bill and you see a charge from the chef, a charge from the expediter who took a look at the plates as they went out the door, a charge from the waiter and a restaurant fee. And you discover that that restaurant is charging 500% more than other restaurants because they're just not known for steak. This is how auto adjudication works. And this is how the insurance companies are paying the bills with your money. And the higher the percentage of auto adjudication, the more waste there is inside your health plan. The next time you talk to your broker or your insurance carrier rep, ask them this question. At what price point does my insurance company run? Request an itemized bill, because the higher the dollar amount, the more waste there's going to be inside your health plan. Now, if you're not sure about auto adjudication or how it works, shoot me a message. And until next time, bear down, focus on the target, and strike out the status quo.