Health Insurance: 3 Ways Today’s HMOs Can Curb Losses

If you are looking for ways HMOs can increase profits by curbing losses, here are the best ways to realise such goal

health insurance and how HMOs can curb losses
health insurance and how HMOs can curb losses

There is nothing new about the rising cost of healthcare and how HMOs are facing significant losses year after year. However, can today’s HMOs curb losses?

Health maintenance organizations (HMOs) is one of the most popular health insurance groups that provides health services for a fixed annual fee. It’s used to determine which doctors your employees can see and at what cost.

Nowadays, there is an industry-wide shortage of providers in healthcare. Also, there is a high cost of technology being deployed throughout every area of healthcare.

health insurance and how HMOs can curb losses

This is why doctors and HMOs are taking huge financial hits along the way. If you are looking for ways to increase profits by curbing losses, here are three ways you just might realise your goal.

#1]. Recover overpayments

One of the leading problems so many HMOs are facing is the sheer number of overpayments. It takes a huge amount of effort to file claims to collect on overpayments. Also, the manpower hours wasted add to the losses they incur.

Why not put technology to work for you? Software from companies like FRG can automate many of the tasks in the process of health insurance overpayment recovery.

Some estimates state that the industry is losing up to $226 billion per year on insurance overpayments. However, your HMO may be getting hit harder than you currently believe to be the case.

Data analytics are a huge part of what FRG’s AccuReports® risk reporting portal can do for you while helping automate overpayment claims recovery.


#2]. Offer limited out-of-network services

Statistically, overpayment for services, according to one healthcare IT news network, is the leading cause for HMO losses. However, second to that is losing large groups of patients/customers to other HMOs that offer a limited amount of Out-of-Network services.

Offering a few out-of-network services is one of the best ways to capture a larger network. It is especially great in underserved areas of the country because some rural areas have extremely limited provider resources.

If those providers don’t happen to belong to your network, individuals and companies are likely to look elsewhere for healthcare insurance. By agreeing to cover a few select out-of-network services, you just might find customer retention will improve.

#3]. Marketing to expand network

Another way in which your HMO might be suffering is through a loss of business because providers simply don’t know you exist! Marketing is key to growing the list of providers who contract with and through your HMO.

By increasing your marketing budget, you can capture a larger network of providers and that can also help to offset those out-of-network services mentioned above.

Why not bring those service providers into your network? The key way to do that, of course, is through ramping up your marketing networks. In a highly competitive HMO to PPO industry, marketing is crucial!

From employer-sponsored/owned HMOs to open networks, these three issues are causing huge industry-wide losses. Technology is a running theme in ways to curb those losses nowadays. It can easily help recover overpayments of losses and/or to prevent future overpayments.

If you haven’t already explored it perhaps now is the time to do just that! As mentioned above, it is estimated that HMOs are losing upwards of $226 billion in overpayments annually from waste, error and even fraud.

Why not look into that amazing FRG’s AccuReports® risk reporting portal to keep overspending to a minimum? This is truly financial and data analytics technology at its very best.



3 Ways Today's HMOs Can Curb Losses
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