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In a recent article published by one of the world's largest re-insurance companies, the following excerpt authored by Dr. Colin Plotkin appears: "As a vendor who continues to work on behalf of several major clients to achieve results better than the standard PPO discounts, Dr. Colin Plotkin has been able to achieve remarkable settlements that are accepted by both providers and insurers."

According to Dr. Colin Plotkin of Dr Plotkin Consulting, hospitals can charge "what they want" There is no regulation regarding the cost-to-charge ratio from a hospital provider, as long as there is no parallel billing and a single "exit price" is charged to every patient. In other words, the original billed amount has to be the same for everyone, insured, uninsured, Medicare, Private Insurer, international or anyone else. The difference comes in how much a hospital provider is willing to discount a bill (the reimbursed amount), and depends on who the payer is, with Medicare recipients getting the most favorable rates.

Dr Plotkin goes on to say that "it is becoming more common to negotiate individually on catastrophic claims in order to mitigate large losses to insurers. Normal, run-of-the-mill, volume-based claims fall under provider contracts. Negotiating behind these contracts, to obtain larger discounts on catastrophic claims is often frowned upon by providers who might argue that if satisfaction occurred with a level of discount on smaller claims, why are those lesser contractual discounts unpalatable on the larger cases? It behooves insurers to put wording into provider contracts that will permit them to negotiate large catastrophic cases. To achieve success and favorable loss-ratios, it is important to use experts in traversing this mine field. This requires negotiators who are well versed in the cost-to-charge ratios of hospitals, average costs, insurance knowledge, medical expertise, legal knowledge, economics, and a host of other attributes. Attempting to negotiate the increasingly common million dollar claim, is not for the rookie negotiator, or the faint of heart".

Date Article Name Download
2013 March Liability implications of PPO use by International Payers PDF
2013 March Who is afraid of silent PPO’s PDF
2013 March Should international payers use PPO networks?  What are the risks? PDF
2012 September What do the changes to the American Healthcare System mean to the Medical Travel Insurance Industry? PDF
2012 September What should an Insurance Payer look for in the selection of a Cost Containment Provider? PDF
2012 February Articles That Have Quoted Us, and Which Appear in International Publications on Relevant Topics PDF
2012 February The Rise of Debt Collections Agencies PDF
2012 February The New York State Surcharge, and its Repercussions on International Insurance Payers PDF
2011 January Articles Appearing in International Publications on Relevant Topics PDF
2010 November Fraud, Misrepresentation, and Various Other Legalities Relevant to the Settlement of Travel and Health Insurance Claims PDF
2010 March The Insurer's Request for Bill Audits and Reviews PDF
2009 Summer Distrust Deepening Between International Insurers and U.S. Providers PDF
2008 October Cost Containment: Working Together I PDF
2008 September Cost Containment: Trends in "Reasonable and Customary" and "Non-Par" Claims PDF
2007 December Cost Containment: Volatile, Misunderstood, No Easy Task PDF
2007 March Cost Containment - what's all the hype about? PDF

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