by Sharon Alt
FSAs, HRAs, and HSAs are all the same – they’re a commodity – if you’ve seen one you’ve seen them all… right?
Not quite.
In order to track claims and pay them correctly, third- party administrators (TPA) rely on complicated (and expensive) software systems.
While not terribly exciting, the software that a TPA uses is vitally important to your clients, possibly more important than great service, good references, and a strong presence in the marketplace.
But because it’s behind the scenes, I wonder how many brokers and employers actually perceive value in the technology that powers their TPA of choice.
As the industry moves more in the direction of consumerism in health care – our only real shot at keeping the government from stepping in and “solving” the problem themselves – there are some challenges we need to find solutions to.
In the absence of first-dollar copayments, for instance, members are responsible for the contracted price for the services they receive. The problem is, consumers have no idea how much these services cost, and, worse yet, neither do the providers.
In order to determine the amount due, the claim must be re-priced by the insurance carrier. This creates a problem for providers who must determine how much to charge at the point of service.
If they charge too much, members might have to make a call when they receive their Evidence of Benefits Statement to request reimbursement.
If providers charge too little, they’ll have to chase down the payment and might end up collecting no money at all. With their accounts receivable rising as quickly as gas prices, it’s no wonder provider groups are so opposed to consumer-directed health care.
So what’s the solution? Is there any way to make all parties happy? In the immortal words of Rodney King, can’t we all just get along? I’m happy to report that a solution might be on the horizon.
DataPath, a privately held company based in Little Rock, ARK., produces software solutions for administering employee benefit plans.
DataPath and Atlanta-based RelayHealth have designed a service to streamline the payment cycle and data exchange needed to expedite consumer payments for health services, specifically through consumer-directed accounts such as FSAs, HRAs, and HSAs.
Providers will be able to obtain real-time eligibility verification of a CDH account and the patient can provide for a secondary benefit payment method to be automatically processed after re-pricing is completed by the carrier.
This will reduce the consumer’s out of pocket costs at the point-of-service, help providers get paid more quickly, and reduce administrative costs.
Sharon Alt is the president of Alt Benefit Consultants, a third-party administrator based in Fort Worth, Texas. Sharon can be reached at 817-731-6258 or sharonalt[at]altbenefits.com.