Medical bills are a top stressor among patients and most agree that dealing with them is highly stressful and inconvenient. In fact, 56% of patients report that generally medical bills are a leading source of stress. Figuring out these bills is also often hard, which leads to confusion on top of the anxiety about the cost itself. Therefore, balance bills can add another source of stress.
To tackle the problem of out-of-network charges, Claritev developed our Data iSight pricing methodology. Unlike Usual and Customary (U&C) or Medicare-based repricing solutions, our methodology recommends reductions using both a cost-up approach (for facility claims) and median reimbursement levels (for practitioner claims) to achieve maximum defensibility, wide provider acceptance, and savings of 61%-81% off billed charges.
Claritev is using machine learning in its toughest and easiest negotiations
Americans are concerned about rising healthcare costs, and among the insured, almost half worry about covering their deductible. With the cost of employee benefits projected to rise, employers and employees are looking for ways to lower costs. Ryan Day, President of HST, a Claritev Company, outlines ways reference-based pricing provides value, transparency, and quality in employee benefits.
When employees and employers think of healthcare, adjectives like, “expensive” and “costly” may come to mind. Health systems, policy analysts, and other healthcare experts agree. They’ve labeled the rising costs in U.S. healthcare as unsustainable.
The beginning of the COVID-19 pandemic in 2020 gave rise to a new way in which payors, providers, employers, and employees look at healthcare. New questions emerged regarding the affordability of provider services, equality of access to healthcare services, and the overall model of how employers can offset organizational healthcare costs while ensuring affordable healthcare for their employees.
Claritev explores why the No Surprises Act will have minimal impact on reference-based pricing.
In November of 2020, Claritev acquired HST. We sat down with HST’s president, Ryan Day, to learn about HST’s past and plans for the future.
A large carrier offering plans with an aggressive Medicare-based benefit limit sought: to satisfy clients seeking greater protections from balance billing for their plan members; to preserve the underlying cost benefits of the out-of-network reimbursement methodology