When it comes to managing claims, medical providers have always worked in the dark. A fundamental lack of transparency into the claims management process has limited what providers can see into the process. It’s meant that providers haven’t been able to identify claims for payment that they should be getting paid on. However, the status quo is changing fast with the rise of insurtech. New claims management platforms are changing the future of insurance and providing providers with insights they’ve never had in the past.
There’s a problem in the insurance industry. Delays in communication, multiple layers of 3rd party interest groups such as attorneys and insurance representatives, and inefficient workflows have been causing long, drawn out processes, partial payments, and market inefficiencies. Communication issues have especially driven wedges in what we call “the provider-payer feedback loop”. The provider-payer feedback loop is the continuous dialogue between insurance provider and payer to ensure a mutual beneficial outcome for both parties. Leveraging innovative claims management software will help to close those gaps and push an outdated industry to begin to adapt with modern technology.
The current medical claims processing rate rarely allows for healthcare providers to receive 100% reimbursement for their services from the insurance carrier. That means the doctors and hospitals that provide the medical treatments to care for injured motor vehicle patients will never receive their full payment.
Why third party liability MVA medical claims are financially eating hospitals and auto insurance carriers alive.
No one saw it coming...Who could have guessed that third party liability MVA medical claims would become increasingly problematic and woefully expensive for the hospitals that treat accident victims and the national auto insurers that pay for it?
Medical costs are rising significantly, and this is particularly true for hospital trauma centers. MVA medical claims range from $500 to $50,000, even for simple, low impact accidents, a.k.a “fender-benders.”
A patient in the Emergency Room is in critical care when they come off the ambulance. Doctors don’t know who the patient is or where they came from -- the EMT says only that it was a motor vehicle accident. Doctors rush to their side and diligently work to save the patient. A job well done.
But now comes the messy part --
According to national data from the Centers for Disease Control and Prevention, Motor Vehicle Accidents (MVAs) represent about four percent of most hospital emergency room visits. While they may be a small percentage of visits, they represent one of the largest pain points for healthcare providers, in regards to difficulty in collections of payment - all due to the complex nature of MVA claims.