CLEVELAND--(BUSINESS WIRE)--aequum LLC, acting on behalf of 400 self-insured health plans and their participants, announces a noteworthy two-year milestone of successfully resolving over 10,000 claims for more than 5,000 member patients, saving over $37 million of disputed charges and earning recognition throughout the self-insured community. Founded in January 2020 as a first-of-its kind tech-driven company in the complex field of medical billing, and arising out of Koehler Fitzgerald LLC, a law firm with a national practice, aequum has significantly grown its industry partnerships with self-funded companies, health plan payers, third-party administrators (TPAs), and brokers seeking support and advocacy services to help members struggling with issues resulting from surprise billing and costs impacting financial “health and wealth.”
Christine Cooper, CEO of aequum, says, “We are helping to protect partners, clients and members/dependents against unreasonable and balance-billing medical charges and successfully address the challenges of maintaining affordable coverage. Our tech-driven team partners with TPAs, insurers, medical cost management companies and stop-loss carriers throughout the country, providing administrative and technical support to these partners and legal support to their members. Working together, we continue to control costs, reduce spending and gain potential savings.”
Cooper emphasizes that aequum strategies and solutions are designed to respond to key industry trends and to help all stakeholders combat inflation:
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Support introduction and member uptake of Health Savings Accounts (HSAs) which are ideal for today's financially fragile workers unprepared for everyday expenses, let alone out-of-pocket medical expenses. HSAs offer a strategic option for employer-sponsored health plans by covering out-of-pocket medical costs in current and future years, as well as Medicare premiums, and provide for retirement income and survivor benefits.
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Implement a healthcare consumerism approach that puts employees in the “driver’s seat.” Supported by new Federal protections including the No Surprises Act (NSA), this approach covers participants in employer-sponsored health plans with protections from surprise medical bills for certain emergency services as well as services received from out-of-network providers at in-network facilities.
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Advance Transparency in Coverage (TiC) rules which now require employers to provide employees with easy access to an online shopping tool featuring 500 shoppable services and highlighting personalized out-of-pocket cost information for covered healthcare items and services. These pivotal transparency mandates spearheaded a massive shift in the role of the patient as a healthcare consumer.
- Increased adoption of a “pure” reference-based pricing (RBP) plan enhances health plan’s understanding of their rights under the NSA legislation and price transparency mandates designed to reveal the true cost of provider health services before receiving care and submitting a claim. RBP plans that do not contract with providers should remain unaffected by NSA because there neither out-of-network claims nor is there any determination of a median in-network rate. A “pure” RBP structure, coupled with tech-driven data support, may avoid unreasonable or excessive provider charges – potentially lowering both the cost of coverage and employee point of purchase cost sharing.
Jack Towarnicky, ERISA counsel, aequum, says “aequum, meaning ‘what is fair and just,’ provides value-added services through turnkey solutions, innovative plan designs, administrative and compliance support, as well as participant legal representation. This support provides members with invaluable guidance to navigate federal healthcare regulations, identify areas to lower risk, reduce costs and maximize value. We are agents of change, employing information technology and data-driven solutions to create a competitive financial advantage for our clients by defending medical balance billing claims and recovering overpayments.”
About aequum, LLC
Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum LLC helps patients defend medical balance bills and brings savings to employer-sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. Visit aequumhealth.com.
