WellRithms, the industry leading payment integrity firm, today released a white paper revealing the ongoing challenges of balance billing in healthcare and introducing a revolutionary captive solution to shield health plan sponsors and members from financial liability. “The Wait is Over: Guaranteed Protection from Balance Billing” unpacks the attributes of a first-of-its-kind captive insurance for group health and workers’ compensation plans that is designed to transfer the risk exposure for excessive claims away from payors and members.

“WellRithms’ Shield Indemnification™, backed by AMI Indemnity, sets in place a legally defensible strategy to reprice individual medical bills and fully absorb that risk,” says Ira Weintraub, M.D., CMO, WellRithms. “Readers will learn the incredible value of guaranteed protection from balance billing, relieving payors and patients from the clutches of collection agencies and relentless harassment.”

While captives have long been used for managing risk in various industries, traditional captives do not effectively manage the risk of individual medical bills, leaving payors and patients vulnerable to balance billing. Attempts at indemnification against egregious billing practices, such as Contractor Liability Insurance Programs (CLIPs) and reference-based pricing (RBP), fall short in protecting payors and members from financial liability.

“WellRithms substantially raises the bar on precision by layering Shield Indemnification™ on top of its proprietary repricing system, Sustainable Claims Pricing™,” continues Dr. Weintraub. “This methodology ensures claims payment accuracy by repricing medical bills line-by-line based upon various factors, including hospital cost-to-charge ratios, geographical cost variations and inflationary adjustments.”

WellRithms is the only payment integrity solution that successfully tackles the ongoing tug of war between payors and providers, extracting patients from the crosshairs of provider attempts to increase reimbursements for medical services, ensuring that providers have been paid appropriately.

Download the white paper here.

About WellRithms

WellRithms saves money for health plan sponsors by Leveling the Paying Field™ between healthcare purchasers and providers. The company serves group health and workers’ compensation payors who seek the most advanced medical bill review system available, the most precise repricing, and unsurpassed plan savings. WellRithms Shield Indemnification™, backed by our insurance captive, sets WellRithms apart by transferring full legal and financial liability from the payor and participant to WellRithms, rendering balance billing tactics, collections, and pressures to overpay ineffective and unenforceable.

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