Often insurance companies will not allow claims to be processed or appear to create restrictions for benefits to be realized by patients of medical and dental practitioners. This is especially true with paramedical practitioners, dentists, and medical equipment suppliers. There are many reasons for this including; arcane adjudication practices, specific benefits design, risk management, claims expense management, and fraud controls.
We work with provincial & national provider associations, and often their lobbyists, to help understand what drives and underneath the issues they face with insurance and group benefits insurance generally. Sound and honest advice is offered on what can be done to improve the situation or challenges faced. From there, we collaboratively develop ideas that provide for a change in the claims practices of insurers in the areas of claims acceptance, or better partnering to avoid fraudulent claims. Perhaps most importantly, we bridge knowledge gaps to provide insurers and employers a better understand the medical providers services so that they can see an offset in claims expense as savings in other benefit areas. This allows wider acceptance of medical provider's patient claims.
Networking is critical to creating win/win solutions for providers, insurers, and employers who ultimately pay the claims expense bills and stand to benefit from improved employee health and dental care. So, we often network extensively on your behalf with insurers, benefit consultants, and insurer associations. This builds trust and a better mutual understanding of issues; essential for solving the challenges associations face.
Contact us to learn more.