My Journey From BUCA to ClaimDOC

The US healthcare system provides an undeniable quality of care, technology, and providers. Yet, these providers are disconnected from the member by a maze of PPO’s that alienate and micromanage care, breed confusion and increase cost and stress on all sides. Perfect healthcare does not exist, however, after over 20 years of working in the PPO world, I set out on a journey to find the best mechanism for efficiently delivering healthcare solutions to plan sponsors. I found the solution with ClaimDOC.

From the 1940s to today, countless government and private solutions have promised efficient, quality, and affordable healthcare and failed to deliver. Today we have reduced the number of viable health carriers to a catchphrase, the BUCA’s. Government regulatory moves have rushed the consolidation of provider and hospital groups into powerful market forces using complicated algorithms to maximize revenue and gaining strong market positions, which leverage BUCA’s into constantly increasing reimbursements. 

Cost transparency, billed charges, discounts, profit, quality metrics, and more are all extrapolated hokum. We all know that change is necessary, and for the fortunate few that want to fight for change, meaningful change is possible with ClaimDOC. Those who worry that change creates too much noise are dismissing the current noise and hoping change will occur from the same sources that made the problems and profit off the current state of confusion. 

Confusion and unaffordable care has created the market option, reference-based pricing. Today, various firms claim to offer the concept of reference-based pricing, when in reality, what they are providing is a little more than repricing strategy tied to a TPA. This can be a dangerous direction for the uninformed. While simple in concept, reference-based pricing has several essential areas to be knowledgeable about in advance, including the claims process, reinsurance contractual positions, legal strategies, provider contracting, member and employer education, and claim settlement strategies. There are many ways for the unaware to be burned by heading down the wrong reference-based pricing path. A partner that is engaged and transparent in the entire process is critical.  

ClaimDOC is unique in its mission of managing health care costs across the entire spectrum of the reference-based pricing landscape;

  • Pave The WayTM is the ClaimDOC program to reach every member’s provider upfront, to clarify the coverage and reimbursement, so the member has no challenge accessing their providers
  • ClaimDOC has a detailed claim audit process that reviews every claim over $2,000 to determine the accurate starting point, generating leverage to reach a fair final reimbursement.
  • ClaimDOC is a co-fiduciary, and as such, the member is not liable for amounts over what is in the benefit summary. We stay on the claim for the life of the claim. ClaimDOC is a partner with skin in the game and focused on solutions that streamline and improve the overall healthcare experience. 
  • ClaimDOC is privately held, fair in our charges through caps, and flexible in our approach to make the relationship with our clients a true partnership adjusting with changes to the marketplace. 

Fair pricing and member advocacy through partnerships with ClaimDOC produce the focus and change that is positively altering the traditional healthcare delivery system. We look forward to sharing the story and the journey with you.