Surprise medical bills have reached a crisis point for our country, with 1 in 5 American families affected by unexpected medical expenses. They affect fully-insured members just as much as members of self-funded plans. The difference, however, is that Flume Health is designed to put member outcomes and patient advocacy first. During Open Enrollment and in our member communications throughout the year, we remind members to always check their bill against their EOB. If there is a discrepancy, they’re instructed to call the Flume Concierge and let us know right away. We’ll record the balance bill in our system and begin addressing the issue, escalating our approach as necessary:
The majority of balance bills can be resolved with a simple phone call. We’ll reach out to the provider and explain why the plan paid the amount it did. We’ll also use this as an opportunity to invite them to join Flume Community, so we can avoid any billing issues in the future.
If the provider refuses to negotiate, or we haven’t reached an agreement after 90 days, we escalate the issue by bringing in a third party expert to negotiate on the plan’s behalf. This service is included in Flume Health’s administration fee and doesn’t involve any extra cost for the plan sponsor.
If six months after the original balance bill was received, the provider has still not agreed to a reasonable price, we work with the plan sponsor to decide whether to settle or litigate the issue. For extra large claims, we can also add another level of third-party escalation, which involves an additional fee. It’s important to remember that most balance bill issues never reach this point. When they do, our primary concern is always the patient’s situation. If the provider has taken credit action against the patient, we won’t agree to any resolution that doesn’t involve the credit action being reversed.
Balance billing issues are often frustrating, and rightfully so. In order to provide members with some peace of mind, we do the following:
• Proactively educate them on the resolution process
• Let them know every time we reach out to the provider
• Carefully track the status of the resolution process and provide real-time updates
Flume Health is committed to providing members with seamless, affordable health coverage. If you have any issues or questions about your plan, call the Flume Concierge at 1-844-MyFlume.
Kevin Schlotman discusses the misaligned incentives in status-quo healthcare plans, and what employers can do to gain independence.
In the fourth part of our recurring series on healthcare arbitrage, we explain how plans can use steerage to help members get the same care at a lower cost.