Cost Containment

Effective cost containment can have a huge impact on corporate expenditure or the profitability of an underwriter.

Increasing expectations regarding the quality of medical care and the explosion of costs in public and private health sectors have contributed to the need for strict cost control. Medical Facilities in some countries are notorious for overcharging treatment. Most of the European Private Hospitals fall in line with the European Regulations, but in some instances, this does not stop them over charging.

one Assist checks and audits the incoming invoices and actively seeks to negotiate reductions on the bills where there are detected errors or items excessively priced.

Many medical establishments will agree to a significant reduction on their bill in return for prompt settlement. This practice is known as "Cost Containment". Most of the cost containment process is carried out in house before passing the invoice for payment to the appointed Claims Handler, using the following guidelines:

• Does the real admission period match the days invoiced on the final bill?
• Is the treatment given acceptable for the illness/injury sustained?
• Have the hospital over treated the patient? I.e. kept the patient hospitalised longer than necessary.
• Has any non-emergency treatment, or any exploratory or remedial procedures been performed that OAL has not expressly authorised.

In some countries, we will utilise the services of specific agents to do the cost containment on our behalf. We find that local agents are sometimes best placed as they know the local cost and the personnel in the hospitals to talk to achieve the best result.