Admission - VOB
- Medical necessity.
- Unlimited benefits.
- Pays at 60% of usual-and-customary billing (UNC) until deductible and out-of-pocket have been met. Then 100% payout.
- $5,000 deductible.
- $12,000 out-of-pocket.
Billing - Claim
- Submitted claims total $70,000 (Minus $12,000 deductible & max out of pocket) $58,000 owed.
- Deductible and out-of-pocket have been met.
- Receive payment after 45 days.
Payment - EOB
- Insurance company "Allowed Rate" total for all claims $11,040.
- Payment amount is $12,600.
- $45,400 still outstanding.
- Payment is approximately 18% of billed amount.
- Claims re-submitted for processing to reclaim deficiency (14 Days).
- 1st appeal (30 Days).
- 2nd appeal plus notification to State Insurance Commissioner (30 Days).
- Insurance company final denial.
Claim Path Solutions
- Claim Path locates all of the low paid claims.
- No upfront fees to the treatment center.
- Estimated increase in payment of additional $22,400.
- 50% of the additional payment goes to the center.
The above outline concludes with the following collection payout to the provider:
- Provider receives: $11,200 (88.8% more collected!)
Claim Path, in this example, increases the center's collection percentage significantly. This type of cash flow increase can mean the difference between surviving and thriving as a business. The benefit Claim Path offers is extremely valuable to any healthcare provider seeking to improve cash flow.