Out of Network Discounts and Negotiations

Identifes the best opportunity for savings on non-participating provider claims

One of the many ways American Health assists clients in containing costs is by offering out-of-network claim repricing and negotiation services. Our Out-of-Network Discounts program offers clients access to a network of more than 300,000 providers, ensuring the best opportunity for savings is achieved on bills that are not covered by a primary network discount.

Flexible options allow clients to submit claims for repricing or to access American Health's Internet repricing system directly to process the claim themselves. A network discount is found for approximately 85%of claims within minutes of entering them into the system. In either option, high-dollar claims and those for which no discount is found are reviewed by an American Health out-of-network claim specialist to ensure that maximum savings areachieved. In situations where there is no match to a network provider, our claim specialists can typically negotiate a discount of 15% to 20% of billed charges. Fees are based on a percentage of savings, so clients pay only for results. American Health specializes in repricing and negotiating the following types of claims:

  • Inpatient and outpatient facilities
  • Dialysis Durable Medical Equipment
  • Surgical Anesthesia Ancillary (home care, infusion)
  • Oncology (radiation, chemo)
  • Rehabilitation (OT, PT, speech, chiropractic claims)
  • Behavioral health

  • Access to more than 250 PPO networks nationwide
  • Identifying the best opportunity for savings on non-participating provider claims
  • Clients can submit claims to be processed by American Health or may access our secure Internet repricing system directly
  • Specialists negotiate discounts if a contract is not available
  • Average cost savings are 15% to 22% for repriced claims
  • Prompt turnaround time
  • You pay only when you save

To learn more about American Health's Out of Network Discounts and Negotiations program, please call us at (866) 614-4244 or send an email to marketing@AHHinc.com.