Over 85% of all hospital bills include charges for services and/or meds that are not received by the patient. (I know this because I worked at a hospital in patient accounting years ago) Please read all.
Insurance companies pay a great deal of money for charges that are erroneous. Currently they are not recouping any of that money. BCBS could initiate a program to recoup some of that money:
After a BCBS customer/insured person has a procedure or goes to the emergency room they can call the provider and ask for a “Detailed Bill”. They go over the bill looking for charges that are incorrect, whether services or meds. Once they identify incorrect charges they contact the hospital, request an audit, and tell them which charges are erroneous. They would then need to fill out a form of some kind for BCBS letting them know that they are having a bill audited.
Once the auditor completes the audit (usually in the patient’s favor) the hospital would send a refund check to the insurance company. They would also notify the patient of their findings.
The big question.....how to get the BCBS customer/insured to put forth the effort?
BCBS sends the customer/insured 50% of the amount the hospital refunded to them. There is incentive for BCBS as well as the customer/insured in this proposal. For the BCBS recouping 50% of erroneous payments is better than the 0% they are getting back now...and they do none of the work to recoup it. For the customer/insured it is a reward for putting forth the effort and going through the process of having their bill audited.