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.

Medical Cost Containment 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

  • 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
  • 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
  • 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
  • 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