Navigating the Complexities of Healthcare Advocacy: A Five-Year Partnership with ClaimsBridge

When did Aequum begin its partnership with Client’s Bridge?

Christine Cooper

We’ve been working together for more than five years now, I believe. It arose out of another relationship and really grew from there.

We got to know each other, got to know Mike, got to know Kevin, and ultimately, because of the work that ClaimsBridge does and the work that we do, we fit together very well as partners.

What are the main services that you provide to ClaimsBridge clients?

Christine Cooper

We provide legal advocacy services, patient advocacy services. We defend balance bills for any plan participants who go to a provider and receive an egregious bill.

We have a partnership with Koehler Fitzgerald, which is a national law firm. We have attorneys there that are defending these bills, but we also have a robust customer service team that is building relationships with the plan participants that ClaimsBridge refers to aequum.

Now that there’s the No Surprise Act, we are also providing services directly to the plans to assist with defending the IDR (independent dispute resolution) claims.

Why do you like working with ClaimsBridge?

Christine Cooper

We love working with them. I think everyone on the ClaimsBridge team is great. Our organizations are aligned in our goals and our mission, reducing health care costs and bringing innovative health care plans to self-funded employers to help attract and retain employees, but also getting good health care plans to the employees themselves.

The ClaimsBridge team is very responsive. I think we’ve just built a really good relationship over the past five years.

There’s the good work that ClaimsBridge is doing as far as doing the repricing and the direct networks that truly help the patients whom we are ultimately on the tail end working with.

It’s just it’s been a very healthy relationship.

Thinking about the totality of the services that you provide, what would you say is the gap in health care that you’re addressing and has that shifted in the last few years?

Christine Cooper

The gap that we’re addressing is advocating for and defending patients when they get excessive medical bills. They get scared and they don’t know what to do with them.

They go to collections and that’s very intimidating for many people. More specifically, we’re alleviating the stress that those plan participants have arising out of any balance bills, or large bills that they’re receiving, any out of network bills, things of that nature.

At aequum, we step in and provide legal representation to the member. The providers then communicate directly with us. The collection agencies correspond with us. And in turn, we have our customer service team that’s communicating with the plan participants. So lifting the burden off the plan participant is one of the gaps that we’re filling.

We also help the employer in their HR function because now you have plan participants that are coming to us instead of taking up time with the HR team.

I would say those are the two primary gaps we address. The other thing is relative to the No Surprises Act. We bring some clarity to the plans so that they know how to respond and we make sure that they’re in compliance with any of the NSA requirements.

And taking the burden off their plate, for both the TPA’s and the plans themselves, we’re handling the open negotiation notices or putting together the packets of information that go into the notice of offer for the actual arbitrations.

How have you seen the impact of the No Surprises Act play out for health plan providers and TPA’s?

Christine Cooper

Right now, the No Surprises Act is still very much a mess and I think there’s a lot of confusion.

The timelines have been constantly moving, the expectations have been constantly moving, so it’s difficult for a TPA or a plan to stay on top of all that.

This is a shift for the plans that Claimsbridge and aequum are working with.

The first issue is whether these claims are even eligible for the process because these providers are putting so much through that really doesn’t even belong in the process to start with.

The second question is: “gee were things paid properly?” So, the problem is overuse of the process by the providers instead of going through the channels that they really should be going through – for reference-based pricing plans that would be balance billing the member (which allows for a strong defense against the unreasonable bill)

And the IDR entities, those arbitrators that are selecting who’s winning and who’s losing are so overworked that from their perspective, I can’t imagine what it’s like to wade through these claims.

You’re getting a lot of inaccurate results and challenging results. The interesting thing, though, is there’s absolutely no enforcement provision and there’s some litigation out there about this right now.

It’s the wild, wild west, and I don’t think we know how this is going to shake out. And I don’t think we’re going to know how this is going to shake out for quite some time. But, from a claim eligibility standpoint, what we’re seeing is claims being dumped into that process and claims that we’re handling or that ClaimsBridge is referring to us, dumped into that process that have no business being there. As a result, one of the things that we’re frequently doing is challenging the eligibility of those claims.

Tell us about a success story that you’ve had for a ClaimsBridge customer.

Christine Cooper

Most recently we received a full write-off for one of the plan participants. The bill was about $4,000. Ultimately, both the plan and plan participant save and such success increase plan participant buy-in on this more innovative plan structure.

Any time we’re getting a full write-off, which we’re seeing more and more, that’s a big success, no matter the size of the bill.

The other is of the claims that we’ve handled for the IDR process that have resulted in a decision, we’ve had seven claims that were deemed ineligible, and that’s the very first argument we make in the process. Getting those claims timely kicked is a success under the No Surprises Act.

Anything else that you’d like to add?

Christine Cooper

I think that just the one thing that I would add is ClaimsBridge has been very attentive to the changes in in the healthcare environment.

I’ve really enjoyed working with Kevin and Mike and others on the team and staying on top of and ahead of those healthcare issues we’ve been discussing. And our partnership has been fabulous in addressing a lot of these health care issues that are ongoing.