Why Healthcare Organizations Are Ditching Their Insurers

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2 Min

What You Will Learn: Why Healthcare Organizations Are Ditching Their Insurers
Source: Wakefield
July 18, 2024
We see a lot of insurance companies kicking ASC’s out-of-network. We also see a lot of ASC’s intentionally moving away from insurers to protect their healthcare organization. Here’s why: Sound familiar to your own struggles? If you decide to go out-of-network with Aetna, Cigna, or UHC, you have Wakefield on your side!
There have been scores of lawsuits this year against the payors. They’ve bullied their way into taking your fair share of reimbursements for far too long. Here are some of their common tactics:
  1. Third Party Contracts
  2. Negotiating lowest possible price upfront
  3. Re-pricing bill
In particular, third party contracts are especially harmful to your healthcare organization, and you may not even know you have one.

If you have one of these contracts, did you know:

  1. The payor does not have to use the contract. They pay a fee to access these deals and will do so when it saves them money.
  2. They cap your reimbursements. If you’ve been offered 80% of your charges on these contracts, the insurance provider would pay you more without it.
  3. There is no patient steerage, and you cannot be “in-network” with a vendor. There is also no referral program.
These companies are backed by millions of dollars, making it nearly impossible for a small provider group to come out successful if court is involved. That’s why you need Wakefield. In order to combat the three payor tactics above, we offer the following:
  1. We will review any 3rd party contract you are signed up with, detail how it is affecting your bottom line, and provide you with options to move forward.
  2. When 3rd party vendors reach out to negotiate an upfront settlement prior to payment, we step in using our proprietary data to maximize these reimbursements!
  3. We leverage our proprietary data to challenge the pricing decision after the payment has been made from the payors and recover you more money.
Remember: there is zero risk to using our services. Just ask!