Features of our One Stop Administration
The Health Benefit Alliance administration team delivers some of the highest and most efficient performance in claim processing. Through proactive intervention, beginning at the onset of a claim, the healthcare plan administrative team ensures that every claim is fully vetted before being paid.
We believe in the prior authorization and pre-certification of services. We also recommend the confirmation of diagnosis and course of treatment for complex, critical and chronic illness. This is not meant to be a barrier to care as services are rarely denied. Instead, it is a real-time insight as to what is happening with each patient at any point in time. Our medical management teams use this knowledge to guide patients to the best, most cost-effective care available.
Our Third Party Administrators utilize claims analysts who are focused on the member’s best interests as well as the responsibility to provide validation of the accuracy of the billing from the provider for the services rendered. When a claim is generated, the team will conduct an extensive review as it pertains to normative cost expectations, medical necessity and the assurance that the service rendered is a covered benefit. An extensive review is conducted to uncover areas of possible savings. The analyst will approve the processing of the claim(s) and only approve the payment of those claims after they have been thoroughly vetted, validated and confirmed as coded correctly.
The Health Benefit Alliance allows you to have access to over 600,000 physicians nationwide as well as virtually every hospital in the United States. This is made possible because The Health Benefit Alliance has the ability to either (a.) select a specific nationally recognized network (b.) combine networks (c.) provide access to virtually all physicians and facilities utilizing reference-based pricing.
Case management is an often under-utilized, but valuable asset. We connect the patients’ healthcare data with clinical, and if necessary, medical second opinion teams while providing transparency into costs and outcomes.
Members are assigned dedicated nursing support (24/7) to address questions and to assist in the course of care.
We strive to protect your employees and your resources. We evaluate the standard of care available and contrast this with national standards. Our team will work directly with providers to secure the most appropriate care from the appropriate source. Our experience is that the highest quality outcome is also the most cost effective.
An important part of The Health Benefit Alliance mission is to improve healthcare outcomes of members by connecting our clients to the foremost medical experts at top-ranked U.S. hospitals utilizing a unique, virtual medical guidance approach, which digitally recreates the experience of a patient walking into the leading medical institutions in the United States. We provide access to the highest-touch coaching, virtual medical second opinions (MSOs) available. This commitment to confirmation of diagnosis and proper course of treatment saves both money and lives.
The correct diagnosis of a serious illness is a complex process and often requires a multi-disciplinary approach. Treatment plans are constantly being updated based on new medical research and innovative discoveries. As a result, both patients and physicians are turning to MSOs as a resource and for reassurance when confirming, amending or enhancing diagnoses and treatment plans.
According to a study published in BMJ Quality & Safety, nearly 12 million Americans are misdiagnosed each year. This equals 1 out of 12 adult patients. And the misdiagnosis has the potential to result in severe harm and costs an average of $386,849 per claim.
Our MSO ally will confirm diagnoses and recommend optimal treatment plans, empowering members and their doctors with the information and resources needed to make medical decisions with confidence.
The documented results speak for themselves:
We offer timely reporting, data mining and outreach efforts to boost and measure utilization. We provide comprehensive road maps for our members and their treating physicians to navigate next steps via our medical second opinion service.
A dedicated Nurse Case Manager facilitates the process from start to finish, collecting all medical records and coordinating the comprehensive medical second opinion review. They will provide answers to any questions that the member or their treating physician may have and offer continuous one-on-one support. Upon completion of the medical second opinion, if requested, a one-on-one consultation between the reviewing specialist and the treating physician can be arranged. Significant resources are available to help the member and their treating physician better understand their medical condition.
• 26% of cases have a change or correction in diagnosis.
• 75% of cases have revisions in treatment plan.
• 18% reduction in indirect healthcare costs (turnover, etc.).
• 123% ROI in gross healthcare costs when there’s any change in diagnosis/treatment plan.
• 600% ROI in gross healthcare costs when there’s a significant change in diagnosis/treatment plan.
The process of making an appointment with a specialist can be difficult to navigate. We handle the confusing stuff, so you can focus on getting better.
We understand your unique needs:
1. Whether you request a specialist online or by phone, we’ll quickly gather information needed
to give you the best recommendations, such as:
a. Diagnosis from a medical professional for your illness or injury.
b. Your preferences for physician gender, age, office locations, languages spoken, and any other factors important to you.
c. Confirmation of any medical records or tests needed for your first visit.
2. We combine data science and the advice of world-class physicians:
a. Our cutting-edge data science identifies the best possible specialists for you based on quality factors, your personal preferences and the oversight of our world-renowned Clinical Advisory Board.
b. Specialist recommendations are based on quality measurement criteria; we have no financial or legal ties to the physicians we recommend, and we do not use online reviews from the general public.
3. We give personal recommendations:
a. You receive detailed bios of at least three recommended specialists.
b. We confirm insurance acceptance, appointment availability and any necessary medical records or tests needed prior to your visit.