Hospital claims may look final on the surface.
But when plans don’t dig deeper, they risk overpaying — missing discounts, coding errors, and medically unnecessary charges that can translate into huge savings opportunities.
On the latest episode of the Business of Benefits podcast, Goodbill CEO Patrick Haig joined host Donovan Ryckis, CEO of benefits consultancy Ethos Benefits, to unpack what plans, TPAs, and employers are routinely missing when hospital claims are paid at face value.
Watch the full episode on YouTube or explore the highlights below:
Nonprofit hospitals are legally required to offer discounted care based on a member’s household income — also known as 501(r) discounts — yet plans are often never aware of them. Haig explains how these discounts work and why they’re so frequently missed.
Paying the bill doesn’t mean the opportunity is gone. If a member qualifies for a nonprofit hospital’s 501(r) financial assistance program, that discount can often be applied retroactively. Haig explains how plans and members can recoup payments, and why many hospitals won’t proactively offer them unless someone asks.
Haig breaks down the discrepancies and overcharges that surface when claims are reviewed on a deeper level, particularly by cross-checking the member’s medical record to validate charges.
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