Out-of-Network Discounts

Provides savings and expanded network coverage through relationships with multiple networks.

One of the many ways American Health contains costs for clients is through reduction of out-of-network costs. The program takes advantage of American Health’s access to hundreds of managed care networks nationwide. In each case, American Health identifies the network that offers the best opportunity for access and savings. Claims that cannot be repriced are negotiated, still offering the client the benefit of substantial savings.

• Claims may be sent to American Health using any of the following methods:
  • Fax or Mail: American Health reprices the claims internally
  • Internet: Clients may use our Internet system to reprice claims from their site
  • EDI: Claims are sent to American Health via electronic interface, eliminating the need for manual entry
• Through Bill Repricing, out-of-network claims from hospitals and physicians are repriced within two business days using network fee schedules. The average savings are 15 to 22 percent.
• Through Bill Negotiation, American Health negotiates price discounts with hospitals and physicians, with savings of 15 to 25 percent.
• Hospital site audits identify overbilling where costs can be reduced. The savings average 3 to 5 percent.
• Fees are based on a percentage of savings, so clients pay only for results: “You pay only when you save.”

To learn more about American Health's Out-of-Network Discounts Program, please contact us by phone at 866.614.4244 or by Email at .