HealthCRM :: We serve families
The U.S. health insurance system has become a “complex labyrinth” for consumers to understand and navigate. Whether public or private coverage, the information needed and the hoops the average health care consumer must go through to use their health coverage effectively is itself a public policy concern, exacerbating continued access and affordability challenges.
From Navigating the Maze: A Look at Health Insurance Complexities and Consumer Protections
Claims and Denials Reports - KFF
Claims Denials and Appeals in ACA Marketplace Plans in 2021 KFF
Claims Denials and Appeals in ACA Marketplace Plans in 2023 KFF
Revenue Cycle Management for Families
Healthcare providers, as a matter of business practice, often retain the services of collection agencies to collect past due bills from patients.
Patients, on the other hand, currently have no access to tools to help them fight claim denials.
We want to build a service that aggregates many of the 42.9 million denied claims (2017 alone).
The service could come up with some interesting insights (such as an aggregated view of what claims are being rejected, by whom, for what reasons). And the service could probably gain leverage over the insurance companies (think of the equivalent of “unionizing” the individual policy holders).
Patients are regularly asked to assign reimbursement benefits to providers.
Well, why couldn’t patients assign reimbursement on a declined claim to the Claim Recovery Agency? Consumers get cash out of selling their life insurance policies. Why couldn’t consumers get cash out of the healthcare insurance claims that are unpaid?
Healthcare providers themselves would be supportive of this concept. If consumers can get a percentage (above zero) of the claim covered by the insurance company, that’s more money for the provider as well. Alternatively, this could be a mechanism to securitize unpaid healthcare claims. Just like “factoring.”