COST CONTAINMENT: "WHAT I REALLY THINK" - AN ANONYMOUS OPINION FROM THE INDUSTRY

COST CONTAINMENT: "WHAT I REALLY THINK" - AN ANONYMOUS OPINION FROM THE INDUSTRY

Alchemy (cost containment) is defined as the process of taking something ordinary and turning it into something extraordinary... sometimes in a way that cannot be explained. Something extraordinary and very profitable.

How do they do it?...

They get a bill for hundreds of thousands of dollars, do some magic and hey presto... the bill is now tens of thousands of dollars and they walk away with the same. Of course the alchemy is never done in the open as this would ruin the spell, always in some private hidden negotiation with the rules of engagement unknown by those not party to the secret .

You may well think if a bill for an inpatient stay starts off at $250000.00 dollars and by some wonderous process is reduced to $1000.00 then the bill was wildly excessive to start with... and of course the people with the magic formula get to walk away a bounty of huge proportions, such is the alchemy.

The mere mortals who pay the bills sadly are not party to this secret rite...

They just pay the bill and send the cost container the gold they have managed to create from a very base metal an over inflated or even fraudulent invoice for medical treatment .

The sheer volume of American cost containers would suggest this is a profitable and lucrative line of business .

What are the tactics?

One very clever strategy is to get authorisation from and insurer to pay a substantial bill and tell the hospital the patients insurance company has rejected the claim and the patient is now self pay and best accept a massively reduced amount than nothing at all . This is guaranteed to knock a few noughts of the bill.

Then there is what you might call insider dealing or even mates rates, an agreement between a provider to charge inflated rates and a cost container to pay them and both make a tidy sum.

At the other end of the scale the strategy is very large numbers of low value claims where a saving of 60 euros is saved from an outpatient bill and the cost container charges 80 euros file fee for this miraculous saving .

Of course not being within the guild of alchemists, sadly, I do not know the full extent of the dark arts of turning a hospital bill into a gold mine.