When the Department of Labor (DOL) recently sued Blue Cross Blue Shield (BCBS) of Minnesota for surreptitiously collecting $66.8M from self-funded plans, alarms sounded throughout the self-insurance industry. Specifically, the DOL alleged that BCBS of Minnesota wrongly passed along a "provider tax" – a state tax paid by hospitals and clinics – to 370 self-funded employer health plans it administers. Industry experts say that the outcome of the case could have ramifications for plan sponsors and advisors nationwide.
Why is this cautionary tale so important?
At WellRithms, we believe it emphasizes the role of plan sponsors and their responsibilities as fiduciary standard-bearers under the Consolidated Appropriations Act (CAA). This legislation lays the groundwork for greater transparency and calls for better due diligence that introduces opportunities for improved employee healthcare outcomes at lower cost. It also provides an example of why the independent Third-Party Administration (TPA) model may be more valuable than Administrative Service Only (ASO) offerings that just manage employee benefits, payroll, HR, workers’ compensation or safety programs.
We align with the objectives of plan sponsors and pledge to work in the best interest of the fiduciary: essentially, what is good for health and welfare plan sponsors is also good for participants and their beneficiaries in a group health plan -- and, of course, the financial well-being of the company. Our services are designed to support these trusted professionals in meeting their fiduciary responsibilities and helping them to seize opportunities for improving benefits, reducing costs, and decreasing waste.
Medical Billing and Payment Integrity: Why We’re Different
WellRithms unlocks opportunities for fair reimbursement, protecting the financial wellness of purchasers by helping plan sponsors successfully tackle problems associated with abusive medical billing as they impact claims management.
Using proven algorithms, extensive data, and AI, our team of experienced physicians and surgeons – not simply coders or ancillary personnel – readily identifies and digs for billing errors, waste, fraud, and abuse. This exclusive level of expertise differentiates WellRithms from other medical bill review companies and enables us to guarantee results.
Another key distinction is our risk transfer platform, appropriately titled Shield Indemnification™. Backed by a captive insurance company, this program moves exposure for excessive claims and balance billing attempts away from payors and members into the hands of WellRithms. We are the only payment integrity company with this capability that fully shields payors and members from financial and legal liability, with a guarantee for the recommended payment amount. This protects carriers, plans, and members from the undesirable and unpleasant impact of litigation expenses and balance billing tactics.
Leveling the Paying Field™
We’re helping plan sponsors significantly reduce their healthcare claims costs while delivering unmatched member protection and guaranteed savings. It’s a commitment that drives our team of physician experts to uncover, review and reprice medical bills – averting medical overbilling costs on behalf of self-funded employers, unions, brokers, and administrators.
Today, there’s no reason why claims errors and deliberate overbilling should cost billions of dollars every year. With WellRithms as an ally, payors prevent those losses and reap the savings.