Ecom PPO.com, IncSM. Announces Solution to Virtually Eliminate Out-of-Network Claims

Share Article

In what they promise will have a huge impact on the health insurance services industry, Ecom PPO.com, Inc. (Ecom) announced today that they are moving their PPO optimization services to a new level.

Ecom PPO.com, IncSM. Announces Solution to Virtually Eliminate Out-of-Network Claims.

In what they promise will have a huge impact on the health insurance services industry, Ecom PPO.com, Inc. (Ecom) announced today that they are moving their PPO optimization services to a new level. In the second quarter of 2006, Ecom will roll out an enhancement of their existing service that will allow insurance companies and payers of all sizes to select PPOs at the member level.

Traditionally PPO’s are selected based on the following; a group basis, on small geographical area (i.e. a three digit zip code), or on a state by state level. The ability to have every member matched to a PPO that has contracts with the member’s providers should virtually eliminate Out-of-Network claims, while allowing all PPOs to compete for lives on a more level basis. Even with the great success that Ecom has enjoyed in the past, its product still leaves as many as 10 to 12% of its clients’ claims dollars Out-of-Network, requiring the use of various vendors with fees that range from 15 to 30% of savings.

With the new Ecom approach, these claims will be covered by the primary PPOs selected with the same capitated rate they are now paying. While Ecom will charge a fee to manage the process, the overall performance of the PPO plan should be greatly enhanced from current levels and at a much lower overall cost to the plan sponsor or insurance companies.

Initial evaluations indicate that Ecom should be able to eliminate most Out-of-Network claims. “We believe this approach will reduce the number of Out-of-Network claims to something less than 2% of the total claims dollars, which should be good for the consumer, result in increased business for the PPOs, and be a great tool for lowering healthcare costs for the plan sponsors and insurance companies,” said Ecom Chairman and CEO, L. Cade Havard.

The company reports that it has begun discussions with two top-level carriers. These carriers currently use their proprietary, carrier-owned networks coupled with various Out-of-Network strategies to eliminate the “White Spaces” but which still leave an estimated 5 to 7% or more of the claims as Out-of- Network. In addition to these two carriers, Ecom is in discussions with a second level carrier, that has indicated the willingness to be the initial test case for taking the PPO selection process to the member level.

“In the past no one had the technology or a sufficient repriced claims repository with an adequate number of PPOs to make this work. We now have the technology, the repository, and the means by which to bring this much needed service to market,” said Rachel Graham, President and Chief Operating Officer.

About Ecom PPO.com, Inc.

Ecom is dedicated to helping insurance companies and smaller businesses increase their profitability and shareholder value with a revolutionary approach to PPO management. Ecom has a proven performance record of taking complex, operational, technical, and/or financial issues and converting them into real-world, cost-effective solutions. Ecom provides total administration of the Virtual PPOSM network along with the most sophisticated Internet tools available to assist in tracking medical claims throughout the payment process. Ecom's client base consists of individual or small group health insurance carriers and self-funded employer groups that have saved millions of dollars per year by choosing Ecom. For more information visit http://www.ecomppo.com/ or contact us via email.

###

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Terri Patterson