Healthureum Will Reduce Health Insurance Losses

Healthureum is optimized to provide a mechanism to reduce health insurance losses that have bedeviled the healthcare sector over the years.  Patients are presently able to make claims and receive compensation on various fronts that the health insurance scheme covers.

Controversies that arise as a result of claims assessed by intermediaries have led to allegations of fraud and record manipulation. While controversies cannot be entirely avoided, the incidents can be better managed to prevent loss of trust on the patient side of the divide.

Here are identifiable grounds for the Healthureum Intervention:

Claims Assessment

When claims are filed by patients in respect of health insurance, they have to be forwarded to claim assessors who have the burden of verifying such claims. Claim assessors might be employees of an insurance company or work externally in the consulting capacity.

Claim assessors who are employees might have to share their data with external claim assessors in the course of verifying patients' claims. They are able to review each claim scenario so that the risk configuration and management are fully understood. 

When a claim is submitted, the assessor will focus on the exact circumstances that gave rise to the claims, where it happened, the time, as well as how the underlying events took place.  The reason for the processes is to ensure that the claims fall within the purview of the insurance cover. The replacement or repair cost involved (if applicable) is considered.

The assessor is also in a position to provide counsel on risk management to the parties involved when the claims are settled. Healthureum comes in here to mitigate the risk of any underassessment that might occur in the course of processing the claims.  The reliability of the patient data stored in the Blockchain and the integrity of all smart contracts is a pointer to the leverage available on the Healthureum Blockchain.

Mismanaged Records

When records are mismanaged, this can impute a condition that will work against either party in a health insurance claim scenario. A missing record can ultimately lead to an under -assessment or overassessment at any point in time. 

It also needs to be understood that mismanaged records affect both the Insurance companies and patients, depending on the underlying scenario. Insurance companies work with reinsurers in order to have their risk minimized.  Any reinsurer will be scrupulous with claims in order to optimize profits and reduce inefficiencies. 

Since records provide the basis to evaluate the terms and application of the insurance terms, providing a trusted means for record keeping is invaluable. Healthureum can serve this end with its robust smart contracts platform that makes it impossible to alter the terms of any agreement. 

Moreover, every condition that underlies the insurance will be easily retrievable and modified only on the consensus of both parties. 

Over-Billing

When insurance companies are billed regarding patient claims, these claims have to be scrutinized and reviewed. In the health insurance industry, it is believed that up to 6 percent of the generality of claims are rejected because of incomplete details.  While this can be viewed as unfortunate, the failure of a patient to get adequate compensation on this score is traceable to inefficiencies in the system.

There is also a school of thought that projects that close to 10 percent of invoices provided are in respect of services that were not performed. This scenario leaves the room for inefficiencies to thrive within the claims assessment and payment window.

The Healthureum Blockchain will not just be a platform to document the terms of each insurance agreement based on smart contracts, but it will also afford users the use of its database. Research reports and best practices will be readily available to guide Blockchain users on documentary processes. 

Account Reconciliation

Wherever there are payments paid in respect of claims, the need for account reconciliation often arises. This as a result of the differential between claims made and actual payments approved as well as disputes that might arise in-between.

When disputes go to arbitration, who pays the bills and how is this received by the parties involved? All of the identified points can become such rigmarole that the resolution of any deadlock might be deferred for too long.

Healthureum Blockchain uses a time-stamp on an automatic basis for all entries made at any point. This can become a vital input in the reconciliation process. By enabling ease of access to patient data and every smart contract, Healthureum supports account reconciliation and makes dispute resolution possible within a reasonable time frame.