Levelling the field
Page said that Travel Guard’s existing process of medical bill review has built-in elements to ensure a fair and transparent payment process. “From both a claims and medical point of view, we will perform a medical bill review to make sure that the details we require in order to make a payment are in place. If there’s anything that we feel is out of place, then we will attempt to negotiate that rate with that particular provider,” he underlined. “Our detailed billing invoices are one key step, and we also (especially with larger providers) enter into direct contracts with medical providers to provide us rates that are in accordance with normal business practices. It’s a step that’s ultimately beneficial to both the provider and us.”
We enter into direct contracts with medical providers to provide us rates that are in accordance with normal business practices
Ensuring security and compliance with regulations when dealing with international healthcare payments is also crucial. Vitesse offers options designed to assist with this. “Vitesse performs sanction checks against payer and payee on all transactions using world-check data. These checks are conducted after the payment is submitted but before they are processed explained Dan Andrews, Insurance Director at Vitesse. “Vitesse has a dedicated compliance function to review and investigate all alerts to establish any true or false matches. As part of the investigation, it may be required to contact a client to obtain further information (RFI) on the payer or payee. All sanction investigations are completed before the payment is released for processing.”
Currency fluctuations
Managing currency fluctuations presents challenges for insurers, in the processing of international claims and settling of payments with healthcare providers. When processing claims, changes in exchange rates can impact the cost of claims and profits. “In countries where the currency is known to fluctuate widely, we pay benefits based on the US dollar, so their benefit structure (and their payment amount) is based on the US dollar,” Page asserted. “This provides consistency to the customer around the amount of benefit that they have, and we know that we’ll have the amount of benefit necessary to pay promptly. But as a rule, in most cases, we buy the currency at the time that we need it.”
When settling payments with healthcare providers across borders, there are similar currency-related risks. Pina spoke to ITIJ about how the international health insurer manages this. “Our aim is to align our foreign exchange (FX) translation and resulting reimbursement to the date of service to make the provider and customer ‘whole’ based on the day that services are incurred. Since the vast majority of provider claims are settled in the local currency, the insurer is absorbing the FX risk,” she explained. “To manage that fluctuation, insurers typically manage their currency holdings based on expected claim reimbursement in each currency. If there are predictable and material currency volumes, effective currency management can offset any FX gains or losses.”
Foreign or local currency?
Nabholz provided an insight into how Helsana manages the impact of currency fluctuations when negotiating medical costs or making payments in foreign currencies. “If there is limited cost coverage, our emergency call centre will deduct a 10% safety margin in each case. The customer may then receive an additional payment,” he stated. “As soon as our customers have the appropriate supplementary insurance, our customers have full cost coverage so that we bear the currency fluctuations. Our financial institution processes our payments abroad in CHF. Currency conversions are carried out by the recipient bank and differences are borne by the recipient. If Helsana is the recipient of payments that show currency differences, small claims may remain outstanding. These receivables will continue to be managed by Helsana.”
Paying healthcare providers in local currency can help manage currency risks, and insurers will often work with local partners to facilitate these payments. Page said that, in most cases, Travel Guard pays providers from one of its regional service centres using electronic payment tools. “But if there were a case that we did not have a relationship with that facility, or they would not accept the payment vehicle (be it credit card or wire, etc.), we do have relationships with local TPAs that we can pay, and then they would subsequently go in and physically pay the bill on our behalf,” he pointed out.
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