Cost-containment for out-of-network claims

Many members develop long-lasting, trusted relationships with their doctors. Unfortunately, not every provider participates in every network. When it’s a key provider or service category that falls out of the directory, this can be a real challenge and frustration for the member. The HealthSmart Payers Organization (HPO) helps members when it’s necessary to go out-of-network.

HPO addresses every aspect of out-of-network claims processing. Whether it’s HealthSmart’s own directly contracted national network or one of our HPO Network Partners, participants can go out-of-network to receive care at a reasonable cost.

  • Quick claim repricing turnaround with an efficient EDI connection
  • Discounts on over 85% of out-of-network claims submitted with average discounts more than 30%
  • Claims repriced at a fair, contractually negotiated rates for fewer unpredictable reductions
  • Minimal access requirements including no ID card logo and no financial incentives or steerage requirements

In partnership with Expion Health, HPO combines our directly contracted provider network, partner networks and out-of-network negotiations to provide access and savings.

30%+ overall average discounts on over 85% of claims