Medical Cost Containment
A multi-level review approach to maximize opportunities for claims savings
Identifying questionable charges that are incorrect, inconsistent, unjustified, coding errors, upcoding, unbundling errors or erroneous.
American Health’s Medical Cost Containment provides a comprehensive solution for clients, verifying that charges billed
are appropriate for the care provided. This unique approach begins with a thorough preliminary assessment of pre-paid
claims by our internal experts. Clients are then presented with detailed findings and recommendations through American
Health’s Bill Audit services and Out-of-Network Negotiations.
Preliminary “Free” Prescreen Review
A free high level prescreen analysis is performed on each
prepayment claim to determine if appropriate for review.
Out-of-Network Negotiations
Our experienced team uses reasonable and customary rates, benchmarking and historical experience to negotiate discounts
on out-of-network charges.
Comprehensive Bill Audit
A detailed line-by-line review that checks for medical bill errors such as
unbundling charges, erroneous charges, inflated charges or coding discrepancies. Bill Audit options are available for
both in and out of network claims.
Product Highlights
- A consultative, multi-level review solution to maximize client savings working with internal experts
- Free prescreen analysis on each bill within 48 hours that includes a review of the plan documents, network and stop loss contracts, and a suggested approach to obtain savings
- Additional savings opportunities through American Health’s medical management services
Testimonials
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I have never been disappointed with American Health's level of customer service. I can't think of a single occasion
where we've asked for something and not received it. We are also very appreciative of American Health's Utilization
Management reports. They're very informative, concise, comprehensive and user friendly to both the administrators and
the clinicians on staff.
Libby Watkins
Director of Health Benefits Management
American National Insurance Co.
Galveston, TX
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There is an account management service philosophy that AHH has as an organization.
Every touch point is a good experience. Good listening, good follow-through and flexibility without compromising
the integrity of the AHH program.
Ann Lervold, MA
Quality & Health Promotion Services Manager
First Choice Health
Seattle, WA
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American Health provides the oversight needed to manage claims costs. Their Case Management
department is customized to meet our clients' needs versus the industry standards.
Michael Lagalante
President
International Benefits Administrators LLC
Garden City, NY
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American Health is easy to work with, very responsive and communicative. Their turnaround time is excellent.
We are very satisfied, especially with the Medical Review staff.
Edwin Embry
Director of Benefits
Cement Masons & Laborers Health & Welfare Fund
Northern, CA
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The reason we continue to use American Health is because we can rely on them for defensible and reasonable reviews of our
non-contracting provider bills (out- of- network claims). We have come to find their services invaluable.
Pauline Hann
Benefits Manager
Carpenters Health & Welfare Trust Fund for CA
Oakland, CA
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American Health is very aware of the needs of our different clients. Any time we have needed
anything, they have bent over backwards to accommodate us. That flexibility has been invaluable. Timeliness and accessibility
have never been an issue. American Health has been a partner in working with our clients, and that's important to our
company.
Kim Wood
Chief Compliance Officer and Consultant
American Benefit Corporation
Ona, WV