The attacks on our systems are constant – not weekly, daily or hourly – it’s a relentless assault. Headlines within our health insurance space are becoming more and more common.
April 2025 | Get the latest from the best RBP advocates and auditors
Industry Perspectives
Jeremy Schuller
Chief Information Officer
As Data Breaches Surge, Is Employee Information Safe?
Cybersecurity threats to sensitive customer and financial information should not be a new topic for anyone. Whether you are a broker or an employer, the headlines on data breaches are common these days. Despite the threats and the juicy stories on celebrities getting hacked, it still seems like a lot of people have their head in the sand regarding how serious this threat is for plan sponsors offering a health plan to their employees.
A couple years ago, I started regularly sharing data on security threats with leadership and they quickly became obsessed with the information. They were deeply invested. The attacks on our systems are constant – not weekly, daily or hourly – it’s a relentless assault. Headlines within our health insurance space are becoming more and more common. Read more.
ClaimTalk
Claim Denials: Their Rippling Effect on Health Plans
Claim denials are a complex piece of the healthcare system, and they can cause frustration for patients and providers alike. There are many reasons claims can be denied, whether it's due to technical errors, subrogation or if it's deemed not medically necessary.
Experts Alex Arnet, Colton Cason and Carrie Kennedy join this month's edition of ClaimTalk to peel back all the layers of claim denials and share their insights on how its time to rethink this process.
Exorbitant Charges Billed by Surgeon and Assistant Surgeon for Spine Surgery
In this Audit Spotlight, we focus on exorbitant surgeon and assistant surgeon charges as it relates to spine surgery performed at a hospital located in New Jersey. The breakdown of physician, practitioner and hospital charges as well as ClaimDOC pricing on three claims is outlined below. And, based on the hospital’s itemized bill, total surgery time for the spine surgery was 2.5 hours. Read more.
DirectAccess+ Savings
DirectAccess+™ clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. The audit team performs line-by-line claim audits to help clients and members maximize their savings. Below is one recent audit result showcasing substantial savings.
Hollywood, Florida
Three-day hospital stay for the treatment of inflammatory scrotal disorder and related procedure
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback From a Member
"I want to thank our member advocate, Christopher, for the amazing support and service! I felt like he took the time to listen to me and knowledgeably spoke to the matter. After speaking with him, I felt at ease. I would be happy to get someone like him every time I called!"
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