Payer Solutions

Our company is designed for those insurance payers with low-risk tolerance—a low tolerance for balance billing of hospital discounts, and deferred liabilities. Realizing a superior net result for both payer and provider, we return on average for our clients, an overall 10% greater savings than accepted industry standard results.

1. Your Reputation

In the provider community as well as the consumer community, a Travel Insurer’s reputation is paramount both to its product success amongst travelers, and also on its ability to manage costs effectively. For this precise reason, our organization places the same emphasis on our reputation, as a travel insurer does on theirs.

In our entire history, Plotkin Health has not had a single lawsuit filed or complaint issued against our company. The reason for this is very much captured in our corporate credo— “Fairness to the Payer, Fairness to the Provider.” We operate in a highly professional, legitimate, fair, and transparent manner together with the various hospital and physician providers not only in the United States, but all over the world as well.

Our commitment to our customers is to always put your reputation, and your customers experience, above everything else. This is a foundation of our business.

2. Our Network is Custom and Robust

We have spent the last 20 years developing our own network specifically designed for international patients. Our organization operates entirely through direct relationships with hospital and physician groups. In addition, we have strategically and successfully established formal contractual arrangements with the more frequently utilized providers in the key destination areas such as Florida, Arizona, California, Nevada, and New York.

These formal contracts are designed specifically for International patients, and are comparatively more flexible and advantageous than the vast majority of Domestic US PPO contracts. For example, all PPO contracts require payments to be made within 30-45 days from the date of services. If claims are paid after this time period, they are likely to become balance bills in the future, with providers having up to 7 years to recover on inappropriately paid claims. Our contracts do not contain this stipulation, and therefore provide our clients with much more time to assess and adjudicate their claims, and which is inherent in appropriately managing International medical cases.

Our organization is also well known as the best available option for out of network negotiations. This ability is utilized not only by our clients, but indeed by other cost containment companies, who recruit our services for this function. With our in-depth knowledge and experience of healthcare within the United States, we use a number of factors, including but not limited to, geographic location of the provider, demographics of the patient, length of stay, providers’ base costs, comparable Medicare reimbursements, and a host of additional information, which enables us to determine a fair and reasonable settlement on a given bill.

Having direct relationships with the majority of providers throughout the United States, and long established historical settlements with many providers, allows us to negotiate more favorable discounts for our clients.

3. Zero Balance Billing and Deferred Liabilities

Having recognized from our inception that the negative impact of balance billing is of major concern to travel insurers, we made this issue a vital component of our operational process. In fact, based on our understanding and belief that there are inherent flaws with the utilization of US PPO and insurance networks by Internationals, our business model was built around the concept of zero balance billing.

The primary factor that enables us to eliminate balance billing in its entirety, is that we obtain a signed agreement from providers on every single account that is processed through our office. Regardless of the size or circumstance of the claim, we know that the only way to prevent balance billing is to work directly with providers, using no third party networks, and to get signed agreements from providers on every single case. This therefore protects our clients and their patients, and enables us to stand behind the results we obtain.

4. Full Guarantee

We do something that no other cost containment company is prepared to do – we provide a full financial guarantee on our discounts for the entire life of a claim. Every single account that is discounted through our office, whether on a $100 claim or a $100,000 claim, comes with an irrevocable guarantee issued by Plotkin Health.

What does this mean to you? If any discount obtained through Plotkin Health is ever disputed by a provider, we assume full responsibility and guarantee that no costs will be incurred by our clients, the patient, or any other responsible party. It becomes our liability and we hold ourselves accountable.

5. Waiving Up-Front Patient Deposits

As hospitals become increasingly focused on International patient accounts being registered with US domestic Insurance or PPO contracted rates, they are taking drastic measures to identify foreign patients at the time of admission and register them appropriately. Not only are they utilizing the services of very aggressive collection agencies (OVAG, Global Recovery, GCS, etc) to pursue payments from insurers, but they are also demanding significant patient deposits upfront at the time of service.

We are pleased to mention that as a direct result of our unparalleled relationships with providers, we are having tremendous success at having patient deposits waived, and avoiding having to deal with these collection agencies. Not only will this translate into a better customer experience for your patients (and better PR for you), but since we are exempted by the providers from dealing with collection firms, it ultimately leads to higher discount levels for your organization as well! This will be a major focus for the coming year.

6. Bill Scrubbing

While certainly not a new issue, the concept of bill scrubbing is gaining more traction in the International marketplace. Recognizing that this is becoming of more concern to Internationals, we are working on internal solutions to identify and appropriately deal with billing discrepancies. In reality, this can be a very complicated matter and has to be handled with the utmost level of care. The patients experience as well as maintaining favorable relationships with key providers have to be taken into account, and will impact the level of action required when billing errors are identified. Going one step further, any dispute on services or billing errors has to be proven, and accepted by the hospital, which is no easy feat. Despite the many claims by audit/bill scrubbing firms, hospitals do not quickly accept unilateral decisions, and often times will fight against claims levied against them.

7. All Invoices

We negotiate on all types of out of network cases, including hospital bills, physician bills, ambulance bills, dentist bills, etc, and successfully obtain discounts on 90% of the cases attempted. There are no bills that are too small or too difficult, and we encourage you to send any claim you may have over to us for discounting.

8. International Discounts

We are making great strides in further expanding our network to include International providers. Tearing down the previous notions that discounts in Canada are not achievable, we have seen tremendous growth in our reach with Canadian providers, and are constantly improving our ability to obtain discounts from Canadian hospitals and doctors alike. We are also seeing a significant increase in meaningful discounts from providers throughout Europe, Asia, and many other foreign locations. As more International medical service providers become accustomed to the level of reliability and fairness that our organization offers, this trend is expected to continue throughout 2015 and beyond.

9. Unrivaled Customer Service

Since our very beginning we have always placed a strong emphasis on customer service, and over the years we have seen the evolution of our efforts being highly effective and beneficial to our clients. The unprecedented responsiveness and total availability of our staff helps us provide information to our partners in real time, and is a cornerstone of our organization. We have set a goal and are formulating protocol that will allow any received communications to be answered within 5 minutes (previously 10 minutes), and which will further assist your staff in dealing with the complex nature of case management.