Self-Insured Employers and Health Insurance Companies Benefit

Plymouth, MI - April 26, 2004

A Plymouth company has positioned at technology’s edge so it can assist giant health care insurers and mid-size to large corporations improve profits by recovering money after insurance claims are paid.

Health Decisions, Inc. has the power to review claims already paid and find enough income in unpaid claims to produce up to a 10-1 return for clients.

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Recovery of Overlooked Claims by Health Decisions Inc. Stops the Bleeding

For more than 15 years Health Decisions, Inc.’s (HDI) claim recovery service has routinely produced a positive return-on-investment for its clients. A review of 100 percent of claims in more than 23 payment areas identifies and recovers claims paid by clients’ plans that are not their responsibility.

In September 2002 Health Decisions, Inc. reported reviewing claims totaling $261 million for selected clients. Expert review investigated and discovered $13.8 million that could lead to recovery and HDI’s powerful software identified $76.7 million that could lead to recovery. Of the almost $90 million so identified, $9 million in claims were actually recovered.

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We’re declaring WARR on waste and abuse in health care. If you share responsibility for a self-funded group health plan or bear risk for health care costs, join the WARR.

WARR stands for:

Waste - Any money paid by your plan that was not its liability.

Abuse - Any party acting in a manner inconsistent with your plan interests.

Recovery - Payment to your plan for “waste” collections.

Resolution - Contracts, policies and procedures that protect plan interests from abuse.

WARR consists of Warriors and the WARR Machine

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The Medicare Secondary Payor (MSP) Program has resulted in an increasing number of employers receiving Medicare Demand Letters. With other finance revenues drying up, the federal government will do what it can to slow the drain on Medicare, Medicaid and Social Security coffers. So Medicare is becoming very aggressive in collecting money from other sources to reduce its own payables.

A worker older than 65 may be covered by the active health plan at his place of employment and still be drawing Medicare payments. If Medicare discovers that it has paid a claim to an employee covered by a private plan, that employer will receive a Demand Letter in the mail insisting that Medicare be reimbursed, with penalty, for the claim that should have been paid for by the company’s health plan.

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How to Peacefully co-exist with Medicare

Decades ago one of the worst pieces of mail a young man could receive was a letter from the U.S. Selective Service System containing a Draft notice - Uncle Sam Wants You! Today, one of the worst pieces a mail an employer can receive from the federal government is a Medicare Demand Letter - Uncle Sam Wants Your Money!

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Money flows when enrollment errors are corrected

Given the rising costs of health care and intensive competitive pressures in the market, self-insured employers, health insurance companies and HMOs are cutting costs and always seeking greater efficiencies in processing claims for healthcare services.

Many self-insured employers and payors believe that the best opportunity to generate additional income is to be more aggressive in health claim recovery, to be sure only claims actually owed are paid.

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