Advanced
Negotiation

Pre-Treatment Capture & Containment
of High Cost and Over Charged Claims

Pre-treatment interventions virtually eliminate retrospective negotiations and ensure the greatest possibility of plan savings.

Hand Shake

Improvement of outcomes through coordinated efforts of clinical care and claim team professionals

What's Inside The Box

Identification

Identification of large claim negotiation opportunities during precertification

  • Dialysis
  • Implants
  • Cancer
  • Out of Network providers

Negotiation

Negotiation of fees before services are rendered for maximum savings

Improvement

Improvement of outcomes through coordinated efforts of clinical care and claims team

Our Process

The Process

  • Refer case from precertification activity to claims negotiation unit
  • Negotiate directly with physicians, hospitals, ancillary service providers and implant device manufacturers to achieve savings opportunities
  • Assume patient advocate role between providers and plan members
  • Guaranteed 100% provider sign-off on all INETICO negotiations

Plan Language is Key

Plan document must include recommended
plan language for maximum impact

  • Defines How benefits are paid

  • Supports Negotiation efforts

  • Yields The most effective cost
    containment while
    maintaining quality of care

  • Protects The plan and the
    member from
    exorbitant fees

The INETICO Advantage

  • Limits cost of implantable device to percentage of manufacturer’s invoice
  • No patient balance billing
  • Negotiations on high dollar cases before treatment is rendered provides stronger leverage and larger discounts
  • Educates members as to their potential financial liability if they choose to use an out-of-network provider
  • Out-of-network events minimized or eliminated
  • Hundreds of thousands $ saved on costly and up charged treatments
  • Required plan language supports the negotiation process, protects the plan and provides greater savings

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