Reimagining Provider Network Management

During my first hospitalization, which lasted for seven days, I was transported by ambulance due to the severity of my symptoms. This occurred before Covid-19 vaccinations were available, and the hospital followed the basic protocol to provide thorough treatment throughout my stay. However, upon returning home, I was surprised to receive a bill totaling $180,000. Fortunately, a significant portion of the amount had already been negotiated with contracted rates. Nevertheless, I was caught off guard by two additional unexpected bills from providers, amounting to $1,425. One of these bills was for a provider who hadn’t even visited me during my hospitalization. These surprise bills directly resulted from the fact that the physicians involved were not part of my insurance network.

This experience highlights the importance of utilizing healthcare providers who are within my insurance network and understanding the implications of network coverage. On average, seeking care from out-of-network providers in the United States can cost around $700, with pregnancy-related visits averaging around $2,000 [Fendrick].

It is crucial to consider these factors and make informed choices when it comes to healthcare to avoid unforeseen financial burdens.

Given my personal experiences, I have developed a strong interest in healthcare Provider Network Management. In previous blog posts, I have highlighted the importance of Provider Network Management and the challenges it can cause. Now, I would like to share my proposed solutions for addressing these challenges.

Reimagining Provider Network Management is of utmost importance for health plans. The accuracy and efficiency of these processes have a significant impact on care quality, cost management, and patient satisfaction. In a 2019 survey, it was found that providers spend a staggering $2.76 billion annually on maintaining provider directories. This further emphasizes the crucial role Provider Network Management plays in today’s healthcare landscape. At Constellation4, we offer a comprehensive suite of solutions to address these challenges. Below highlights our solutions.