Bill negotiation: a win-win for health plans & members

August 10, 2021
Josie Rasberry

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When your health plan is looking to improve offerings and meet member needs, most solutions you think of are more than likely proactive. By proactive, I mean that the services you’re going to potentially add likely help members before they have a healthcare experience. For example, healthcare navigation tools, care management platforms, wellness offerings, preventative services, etc.. While we are big fans of prevention, the reality is sometimes unpreventable healthcare events happen and you need to have a resource for your members in this situation. For these instances, I’d like to introduce you to bill negotiation. Even if you’re familiar with bill negotiation already, this blog will be a good refresher on what exactly it is and why it’s such a win-win for you and your members. 

So what is bill negotiation?

Let’s say that despite all the great healthcare navigation tools you provide and the clear documents you’ve given members to make sure they understand their coverage, they still go to a provider who is out-of-network. Or they see a specialist whose services they thought your plan covered but doesn't. Even more likely, let’s say your member, unfortunately, had an emergency situation and was rushed to a hospital where they had no choice in who gave them care. In all those scenarios, you get sent an expensive claim that you don’t cover and then your member gets stuck with a high medical bill. That’s where bill negotiation is a lifesaver. A third-party patient advocacy company will give your member a dedicated patient advocate to negotiate down their medical bill for them. The patient advocate will exhaust every avenue in a best-efforts attempt to lower the medical bill. And more times than not, they do! See this 2-minute video to see how one patient had her $200,000+ bills reduced to $2,990:

How is it a win-win for my health plan and members?

The biggest and most obvious win is that bill negotiation lowers medical costs, but there are so many more benefits than that. When members receive an expensive medical bill, who do they typically blame? You, their health plan for not covering it. With bill negotiation, you can not only avoid that anger but also turn a negative experience into a positive experience. When members see that you offer an independent service to lower their medical costs for them, they’ll feel truly cared for. This of course increases your member satisfaction ratings and your online reviews, which in turn leads to better retention and higher member growth. 

Even members reap benefits besides lower medical costs when they have bill negotiation. Mainly: confidence. One study found that 1 out of 4 patients skip an appointment or follow-up for fear of medical cost. That is detrimental not only to members’ health but to your health plan too. As more and more members continuously avoid medical care, they eventually get to a point where their medical problems can’t be ignored anymore. And by that point, the care they end up needing is far more expensive than a preventive care appointment or medication they should’ve been on. But with bill negotiation, your members will know they have someone to advocate for them in case they do get hit with a surprisingly high medical bill.

Final thoughts.

Third-party bill negotiation is an affordable solution to better control your overall costs. Not only will bill negotiation lower your members’ out-of-pocket expenses, but it will also increase member satisfaction and retention! To learn more about how bill negotiation can help your plan, and read patient testimonials visit our Bill Negotiation page.

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Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download Your Guide to the Transparency in Coverage Rule

Discover how the the new rule will affect TPAs and health plans and how you can start your journey to compliance.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Sedera Case Study

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Lowering Organizational Member Cost Guide

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download The Lowering Organizational Member Cost Guide

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

Download Healthcare Consumerism 101: A Playbook for Health Plans

Learn the best strategies and tips for retaining your members while keeping costs low.

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