Issue:

About Quest | Mission | Value

Out-of-Network (non-participating provider) medical claims are a common problem for payors. These claims increase administrative time, overhead, loss ratio and overall expenditure. Traditionally, an insured member is covered by a plan utilizing a preferred provider organization (PPO) and enjoys the benefits of that plan, but without a contracted PPO provider in place for that claim, the payor and the insured incur the provider’s full billed charges.

The managed care environment, like everything else, has felt the sting of rising health-care costs. So why are costs skyrocketing?

Increased cost of drugs, medical devices and medical advances.
Rising provider expenses.
Government mandates and regulation.
Increased consumer demand.
Litigation and risk management.
Fraud, abuse, miscellaneous.
General inflation.

It is vital in today's managed care environment that new ideas and solutions be implemented to control the upward trend of health care costs.

Solution:

Quest Medical Claims

Quest immediately answers the issue by lowering non-PPO claim costs by providing dependable cost-effective healthcare management solutions to our clients.

Skillful claim negotiation averaging 20%-25% off allowable billed charges.
Discounts acquired on eighty-percent of the claims submitted to Quest for repricing.
Web Based National Provider Network offering over 3,400 hospitals, 440,000 physicians and 39,000 ancillary providers for immediate repricing.
Quest is a performance-driven company that does not charge to negotiate a claim that does not acquire a discount.