April 20, 2020

Intro to Direct Contracting

Dean Graham

Direct contracting increases our ability to audit claims and catch fraud or abuse, as well as guarantee fair pricing for services and procedures.

The network model for health coverage relies on rates that your insurance carrier negotiates with providers in advance. The problem is that a broken and opaque negotiating process often leads to rates that are significantly higher than the actual cost of providing care. Network contracts also make it nearly impossible to audit healthcare bills for fraud, waste, or abuse, and they can include provisions that might put plans in financial jeopardy.

 

What is direct contracting? 

Through Flume Community, we sign contracts directly with providers who agree to see all of our members at predetermined prices, set as
a percentage of Medicare reimbursements. This allows both the plan sponsor and member to know the price of an appointment ahead of time, and mitigates the risk of the member receiving a balance bill. Direct contracting also increases our ability to audit claims and catch fraud or abuse.

 

Do I have a say in who Flume Health direct contracts with?

Yes! Members can nominate providers at any time through my.flumehealth.com. When we receive a nomination, we’ll reach out to the provider and invite them to join Flume Community. If they join, all of your employees can benefit from that provider.

 

What's the incentive for the provider?

Providers who join Flume Community are paid within 72 hours of receipt of a clean claim. They don’t have to worry about trying to collect deductibles or coinsurance from the member, since those costs are covered by the plan. They may also see higher utilization, since we’ve removed the out-of-pocket expenses that often keep people from seeking care.

 

What if a provider says no? 

If a provider declines to join Flume Community, members can still see them under their Open Access health plan, they’ll just have their regular deductible and coinsurance obligations.

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.

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