Picking up from the one-page summary, this QR code links to a typical letter we plae on file with the hospital. Emails for the ERs and admissions departments are never listed, so we send these to whoever we find in our database. It is then up to that person to forward the email.
If they don't and the ER claims they never saw it, that's on them. You can't make yoursel uncontactable and then complain because you weren't contacted.
Or, as they say in law school, you can't murder your parents and then ask the Court for sympathy because you're an orphan.
Q: What if we are already negotiating with a hospital for direct contracting?
Chances are that your direct contracting involves steerage and a narrow network, so they are exchanging a mroe favorable price for more elective business. Few hospitals will direct-contract for emergencies, for the simple reason that you can't steer them.
Further, if you are direct-contracting or negotiating the same, you can use our autoConsent as a cudgel to induce more favorable pricing overall, or sweep emergencies into your contract.
Q: Does it matter whether a hospital is in-network or out-of-network?
These days, the prices for both are converging. Out-of-network surprise bills are generally capped at the in-network price (though a higher share is paid by the employee)...but in-network fees are rising.
The only difference is that in theory, some insurance company contracts with employers have a clause prohibiting an employee of the group from getting covered if they pay less than the amount they are supposed to pay. This makes no sense and only once in the 3 years we've been offering this Consent has a carrier dared to threaten this. We described the "Streisand Effect" to them and agreed to keep the whole thing between us, and of course they caved.
And it's your money they are "covering" it with, so there's that...
These clauses are never found in TPA contracts, by the way. And a few TPAs already offer the Quizzify autoConsent.
Q: How do we get this QR code on our insurance cards?
Continuing the TPA thread, these claims-payors allow larger groups to design, or influence the design, of their own cards. So adding this QR code is not a problem. Carriers may refuse because these prices undercut their own, and they want to avoid that embarrassment.
In the latter case, we send stick-ons for employees to use.
Q: How do we get employees to use this autoConsent, if they have already reached their deductible?
They "use" it automatically. We do strongly recommend using the autoConsent in conjunction with Quizzify Classic (our monthly healthcare trivia games), and we toss in a question every month or two on the autoConsent, just so they know what's going on behind the scenes.
We also recommend a savings-share. Like if their bill is under $1000 (or under $1500 and involves a procedure), you reimburse their copay or give them some points in your incentive program.
Q: How will we know whether they (meaning you) got correctly billed or not?
The bill is correct the large majority of the time. Hospitals are very aware of EMTALA. There are two ways of managing the exceptions:
Ideally, you create a rule that ER bills over $1000 and all emergency admission bills over $20,000 (this number may vary, depending on the market and the hospital) are flagged or manual review. A quick glance (by Quizzify or other expert) will reveal whether the autoConsent was applied.
Leave it to the employee to flag the bill, directly to a third-party reviewer, if they think it is too high. (Remember, they have the incentive to do this.)
Q: What is they aren't correctly billed?
Either us or your own repricing vendor (whom we train for this purpose) simply calls the hospital and gets it repriced. No negotiation involved. The hardest part is actually finding the right person to talk to, but we can help there as well.
Q: Doesn't this seem like a lot of work?
Show us anything else where you can reduce overall spend by 3 points or more (except in Maryland) and refund employee copays or give them points in an incentive program, for less effort. (Most of the work is on our side.)