It is the employer who promised to pay the lion's share of their employees' health bills, usually 80 percent. The insurance company is the plan administrator.
Rockford, IL (PRWEB) October 23, 2009
Millions of American workers struggling to pay their medical bills may not even be liable for them, according to a fast-growing private company in Illinois.
Celebrating its two year anniversary, Rockford-based CRC (Claims Recovery Company) diligently works to analyze denied claims and recover funds owed to hospitals by employer benefits packages.
The swift and solid growth CRC has seen during its short lifespan comes as no surprise to its founders. Chief Executive Scott Winslow, a former hospital CEO, understands the system--and the loopholes--which big insurance companies exploit. "Literally millions of dollars--perhaps billions--go unpaid because of denied claims from insurance companies. Many of these dollars are clearly payable by employers under the Employee Retirement Income Security Act (ERISA) of 1974," Winslow explains.
CRC's experts identify improperly denied bills through a complex process of research, review and application of federal laws. They have successfully resolved thousands of unpaid insurance bills totaling millions of dollars all over the U.S. since their start just two years ago. With over 170 million American workers covered by such plans, the potentially recoverable funds are staggering. Adds Winslow, healthcare reform is sure to add millions more workers to the pool.
Winslow cites data from the American Hospital Association that estimates the average payment to hospitals at about 35 cents paid for every dollar billed. "That's about $2 unpaid for every dollar that is paid," he said, adding, "The worst of these stories are the ones where the patient ends up losing everything they own trying to pay their healthcare bills."
In fact, Harvard University recently released a study stating that medical problems contributed to over 60% of all personal bankruptcies in the U.S. in 2007. CRC finds that health insurance companies frequently dispute their responsibility for bill payment and often, simply don't pay. These disputes can go on indefinitely. The unpaid charges with demand for payment can appear in the patient's mailbox even years after treatment.
Winslow credits his staff's unique depth of ERISA knowledge as the reason for the company's rapid growth in a slow economy. CRC seeks out specialists from the health care finance arena who have become experts in these complex federal regulations and laws.
"Employer based insurance is shorthand for ERISA," Winslow explains. "It is the employer who promised to pay the lion's share of their employees' health bills, usually 80 percent. The insurance company is the plan administrator." The explanation of benefits from the insurance company is daunting for people unfamiliar with the lingo. Many see the large dollar amounts and just freeze; the numbers can be shocking.
While CRC does not work directly with consumers, its resolution of claims for hospitals and other providers is really on behalf of the patient.
Companies competing for talent offer good health benefits. According to Winslow, "Any promise made to a worker is called a benefit. ERISA law states that if a company makes a promise of a benefit to a worker and breaks the promise, they may have violated the law and could be subject to penalties, including fines and even jail.
Winslow advises anyone covered by an employer plan to check with their Human Resources department to make sure that all benefits under ERISA were received on disputed medical bills. "Or just go to a hospital that uses CRC, and we will do it all for you," he quipped.
About CRC: CRC (http://www.crcclaim.com) was founded in Rockford, Illinois in 2007. CRC conducts a detailed analysis of denied claims and appeals bad debt health insurance claims (up to six years old) under federal ERISA law as a patient advocate. CRC is headquartered in Rockford and serves hospitals and other providers throughout the United States.