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1. HEALTH Claim COST CONTAINMENT SOLUTIONS Presented
by
London Medical Management, Inc.
2. DISCUSSION Health Claim Cost Containment Solutions
Unique combination of Health Claim Negotiations with Patient PALTM advocacy services
3. HEALTH CLAIM NEGOTIATIONS
3 Buckets of Claims
4. HOSPITAL STOP LOSS PROVISION
Protects the Hospital, NOT the Client
5. HEALTH CLAIM NEGOTIATIONS
3 Buckets of Claims
6. HEALTH CLAIM NEGOTIATIONS
Process
7. HEALTH CLAIM NEGOTIATIONS
Process
8. HEALTH CLAIM NEGOTIATIONS PROVIDER DATABASE
9. HEALTH CLAIM NEGOTIATIONS
Claim Fact Sheet
10. HEALTH CLAIM NEGOTIATIONS
Claim Fact Sheet
11. Claim Negotiations Protocol
12. Negotiations for a Fortune 500 Company working with a nations leading health plan
14. PATIENT PALTM
15. Patient PAL Care Continuum
16. Electronic Medical Record (EMR)
17. Patient Referral Source
18. London Medical Management
Contingency Fee
19. WHAT WE HELP YOU ACHIEVE Decrease the total cost of health care through direct negotiations of individual patient claims
Enhanced benefit plan design with the addition of Patient PAL at no additional cost
Patient PAL stand alone service annual cost - $54,000 for 1,000 member employer group
20. Our Value Proposition We assist insurers and employers to reduce the cost impact of large claims through direct negotiations with providers. We utilize the savings from these negotiations to help employees and their dependents navigate the complexities of the healthcare system through our PatientPAL program.
21. Our Clients Include:
22. SUMMARY Health Claim Cost Containment Solutions
Unique combination of Health Claim Negotiations with Patient PALTM advocacy services
23. Frequently Asked Questions Q: How are negotiations done?
A: Knowledge-based negotiations with information available through internal negotiation database.
Q: Is existing discount negated?
A: Existing discount is never negated. Thats why allowable amount is critical to have so that LMM negotiates an additional
discount.
Q: Does LMMs interface impede with TPAs performance guarantee?
A: TPAs performance guarantee is NOT impeded due to set negotiation time frame.
Q: Who pays LMM fees?
A: Client pays LMM fees.
Q: What is the provider payment monitoring system?
A: Once negotiations are complete LOA is sent to client TPA for payment; LMM reaches out to provider to verify receipt of
payment.
Q: How is the claim information exchanged?
A: Excel format, usually exchanged through clients FTP/secured server.
Q: How often is client invoiced?
A: Monthly
24. Frequently Asked Questions Q: What is included in the invoice?
A: All negotiated claims showing Billed Charges, Allowable, Final Payment and Savings.
Q: How long is the set-up process?
A: Usually two weeks from signature of all agreements.
Q: Does TPA charge additional fees for pulling/pending claims?
A: No, because LMM provides value added service provided by the TPA.
Q: Is Allowable or Payment negotiated?
A: Negotiations are based on Allowable amounts.
Q: What happens to patient responsibility, deductible and/or co-insurance upon successful completion of
negotiations?
A: Patient responsibility still applies.
Q: What are the next steps?
A: Health Plan LOI; BAA; Contract with LMM; analysis of health claims retrospectively to show potential
savings had LMM been involved.
Q: How does Patient PAL work with Case Management or does it replace it?
A: Patient PAL does not replace but rather enhances Case Management, where Case Management serves as
authorization entity and Patient PAL serves as facilitator of prompt and best medical care.
25. LMM Contact Info Corporate Headquarters
Contact: Jack G. London, President/CEO
Phone: 702-737-7555
Fax: 702-737-7504
Address: 11920 Southern Highlands Pkwy, Suite 103
Las Vegas, NV 89141
www.LondonMedicalManagement.com
www.PatientPAL.org
