Out of Network Claims Explained One of the most significant inefficiencies in health care is the pricing strategy of health plans regarding their policy on reimbursement for members who receive medical services from health care providers who are not contracted as part of the network that is managed by the health plan. In other words, [...]
Since most of the cost containment and settlement solutions vendors do charge the plan, this actually works against the health plan's ability to manage their expenses and comply with regulations. Health plans should look to solutions that support the MLR calculation and regulations, and maximize the speed and the amount of reimbursement to the provider.
on November 22, 2010 the Obama Administration's regulation implementing new standards for the “medical loss ratio” provision of the Affordable Care Act will make the insurance industry more transparent and is intended to enable consumers to purchase health insurance that provide more value for every dollar paid for premiums.