Providing Access to a World of Care

Providing Access to a World of Care
UnitedHealthcare International’s
Cross Border Solutions
™
Go further. Do more.
Go further. Do more.
© 2012 United HealthCare Services, Inc. The service marks contained in this literature are owned by UnitedHealth Group Inc., many of which are registered service marks in the United States
and in various countries worldwide. Confidential property of UnitedHealthcare. Do not reproduce or redistribute without the expressed written consent of UnitedHealth International. UnitedHealth
Group does not provide medical care and cannot guarantee clinical outcomes. Products and services may be limited or excluded by applicable law.
Go further. Do more.
04/12 PG
100-2368
Savings, Meet Service
The U.S. health care system is costly and complex – and as business
expands beyond borders and individuals and groups spend more time
traveling globally, it is becoming increasingly important for all companies
to efficiently and effectively manage their U.S. health care risk.
The solution? UnitedHealthcare International’s Cross Border
SolutionsTM, a strategic, integrated health program that successfully
manages risk and U.S. health care costs for U.S. and international
insurers, government entities, third-party administrators, assistance
companies, self-funded plans, claims handlers and expatriate programs.
It is our belief that sustainable U.S. cost containment requires more
than discounts. That’s why Cross Border SolutionsTM creates
accessible, affordable, high quality health care programs that
provide measurable business solutions. Our programs provide:
• Advanced Care Coordination: Our programs and services use the
best evidence-based medicine to monitor care before admission
through follow-up services, helping individuals access the right care
at the right time and in the right setting.
• Superior Customer Experience: Our reputation in the industry
for delivering the highest level of customer service stems from our
state-of-the-art claims and customer care systems, and our personnel,
who simplify the administrative processes for you and your clients.
• Simplified Provider Payment: We provide direct payment to
hospitals, physicians, laboratories and other health care providers.
No “balance billing” is permitted in our network for covered services,
and we work actively with health care providers to make certain
they understand an individual’s benefits and coverage limitations.
•
Unmatched U.S. Network: We provide access to UnitedHealthcare’s
U.S. network of more than 5,200 hospitals and health care
professionals and 650,000 physicians, the industry’s largest
proprietary network.
• Innovative Intelligence: Our systems, programs and services
benefit from the insight and innovation of UnitedHealthcare. We
stay on the cutting edge by listening to our clients, then using that
information to build strategic tools and concepts that bridge the
domestic and international health care communities.
• Seamless Claim Administration: Our sophisticated claims
administration includes a wide array of proprietary automated
claims edits to promote correct billing and benefits administration,
effective cost containment and clear reporting.
• Complete Transparency: We provide complete claims transparency
so you can better understand your costs and savings. This open
exchange of information allows us to cultivate trusted relationships
with our clients.
• Unique Claim Arbitration: We successfully negotiate out-of-network
claims by using an advanced claim arbitration tool that belongs
exclusively to UnitedHealthcare International and is powered by
the knowledge and experience of our claim arbitration specialists.
• Valued Partnership: Our size, experience and depth of expertise
make us a reliable resource and partner for our clients. Always
available to explain, educate and clarify, we work hard to help our
clients understand the U.S. health care system.
The Benefits are Clear
When You’re United
About UnitedHealth Group
• Fortune #21
• America’s largest health care company
• Approximately $93 billion in sales (U.S.)
UnitedHealthcare International’s Cross Border SolutionsTM
is unique in the market space. No other program can provide
the same level of savings, service and expertise within the U.S.
health care system.
• Serves more than 73 million people worldwide
• S
pends $100 billion per year on U.S.
health care services
• R
eceives 50 million telephone service
calls annually
Why? Our programs are all delivered as an extension of
UnitedHealthcare, a recognized leader in the U.S. health
and well-being industry that uses the power of information
and innovative thinking to:
• T
ouches nearly every aspect of health care
financing and delivery
• R
anked #1 in Health Insurance Innovation
by Fortune Magazine
• I mprove the quality and effectiveness of health care for
all people
• Enhance access to health benefits
• U
se technology to make the health care system easier
to navigate
• C
reate products and services that make health care
more affordable
And because UnitedHealthcare International is an operating
division of UnitedHealth Group, the largest single health carrier
in the United States, UnitedHealthcare International Cross Border
Solutions is able to capitalize on our parent company’s assets:
size, scope and unparalleled innovation.
The Result? Better information. Better decisions. Better health.
To learn more contact us at 866.527.0549, email [email protected], or visit us at www.uhgi.com.
Travel: Quick Solutions. Big Savings.
When it comes to individuals visiting the U.S. on short-term travel
and needing health care, our goal is to minimize loss while offering
convenient, high-quality care. We do so by providing Hygeia® PPO
and Hygeia® Arbitration Services.
Hygeia® Arbitration Services provides a proven solution to address
out-of-network claims using powerful proprietary databases and
a negotiations methodology that result in a binding settlement
with the provider. It provides:
Hygeia® PPO is the market-leading international managed PPO
solution, offering high performance and compliant access in a flexible
PPO model. It provides:
• 25-30% average savings on claims spend submitted
• The ability to aggressively control costs
• Excellent coverage at accredited health care providers
• 35-45% average savings on network claims spend
• An average of 90-95% coverage of all claims dollars
when coupled with Hygeia® Arbitration Services
• M
anaged care compliant model that is respected by
and respectful of health care providers
• P
roprietary technology, including the largest database
of international claims in the industry, to benchmark
appropriate reimbursement levels
• Highly skilled and trained arbitrators
• E
xcellent provider relationships, resulting in a successful
and sustainable arbitration model
• S
igned documentation from the provider clearly stating
the negotiated amount accepted to settle the account
• S
uite of multiple award-winning technologies and
superior customer service
Your Needs are Unique. So are Our Offerings.
At UnitedHealthcare International’s Cross Border SolutionsTM, we
are continuously evaluating our products and solutions to ensure they
meet the needs of the evolving health care market.
While the needs of each segment are unique, Cross Border Solutions’
differentiating factors remain constant. We provide:
Our expertise in the U.S. health care industry and our knowledge of
the most recent trends and best practices allows us not only to provide
superior services, but also to offer the industry insight and education
you need to make informed decisions and minimize your U.S. health
care risk.
• Award-winning technology
Our more than 15 years of providing Cross Border SolutionsTM has
proven that one solution does not fit every customer – which is why
we have structured our offerings under three unique care segments:
• Lower administrative costs
• Dedicated account management team
• A
dditional savings with bill editing
and integrated care coordination
• Long-term growth potential
Travel, Medical Travel and Expatriate Care.
To learn more contact us at 866.527.0549, email [email protected], or visit us at www.uhgi.com.
Medical Travel & Expatriate Care:
Superior Service. Unmatched Access.
Medical Travel
Expatriate Care
When your clients travel to the U.S. specifically to receive highquality medical coverage, they are expecting the best – and that’s
what they deserve.
Your expatriates don’t want to feel like visitors – and they shouldn’t
be treated as such. That’s why Cross Border Solutions provides
superior health insurance coverage and services for your expatriate
employees living in the U.S.
At UnitedHealthcare International’s Cross Border SolutionsTM,
we roll out the red carpet for medical travelers, acting as their personal
concierge throughout their stay and providing them with access to
the facilities that provide demonstrated quality and cost efficiency.
Our unique “VIP Service” covers all aspects of their health and
well-being – from offering transportation at the airport to helping
them find the right hotel for their recovery period.
Our expatriate health insurance coverage and services offers employees
the same benefits, and same treatment, as their U.S. counterparts.
They’ll have access to UnitedHealthcare’s best-in-class programs and
service, as well as our expansive U.S. network of hospitals and providers.
And they’ll access it all using their UnitedHealthcare member card,
just as they would if they were U.S. citizens.
Most important, individuals requiring highly specialized care for
illnesses such as cancer, cardiac disease and organ transplants benefit
from United’s Centers of Excellence network and Complex Condition
Management protocols. Taken together, these services offer the
insured simplicity, quality and affordability unmatched in the industry.
Delivering on Our Promise
Medical travelers and expatriates will access UnitedHealthcare’s
programs and services through UnitedHealth Access (UHA),
the premier U.S. comprehensive medical cost-control solution
for qualified International Payer Organizations.
• Fixed-fee contracts (per diem and case rates), providing the highest
savings potential and a powerful disincentive to overutilization
Offering unrivaled cost control for your U.S. medical risk, UHA is
simply the best way to access care in the United States. It provides:
• C
laim edits that filter for incorrectly coded charges and yield
additional savings
• Options PPO, the leading PPO network in the U.S., used
by the largest U.S. employers and 25 million individuals
• e Service reporting tools that are available 24/7 via a web portal,
giving you access to a suite of financial, claims-related reports and
the ability to reproduce Explanation of Benefit (EOB) documents
• C
are coordination, providing case management through
well-established protocols on every admission, automatically
• 5 2% savings on average (excludes additional savings from claim
edits, care coordination, subrogation, adjudication, etc.)
• A
ccess to 650,000 physicians (7 of 10 physicians in the U.S.)
and more than 5,200 hospitals (8 of 10 hospitals in the U.S.)
United’s Centers for Excellence network allows for
better complex care decisions, resulting, for example,
in a 68% reduction in re-transplant rate.*
* Based on BOB performance for clients who have adopted service. Actual savings depend upon illness burden, final program adoption, and any customization.
• S
uperior coverage (Two out of three available doctors and health
professionals are part of our network, providing local access
to 98% of the U.S. population. 99.6% of hospital agreements
are renewed without notice or disruption.)
To learn more contact us at 866.527.0549, email [email protected], or visit us at www.uhgi.com.
Before
Medical
Episode
During
Inpatient
Stay
After
Patient
Discharge
We Take Care of You – and Your Bottom Line
Cross Border Solutions makes care coordination and medical
management a priority – because by positively supporting physicians in
the delivery of care, we are also positively impacting your bottom line.
TM
Our expertise in coordinating care that’s medically necessary, appropriate
to members’ conditions and provided in the most appropriate,
cost-effective settings allows us to offer the best available solutions
at the best available rate. This, combined with UnitedHealth Group’s
buying power, ensures that you maximize your savings, every time.
Our health solutions begin before a medical episode occurs and continue
after patient discharge.
Throughout the entire process, your dedicated account management
team will work with you to provide the information you need to
minimize loss while exceeding member expectations. You will receive
daily, weekly and monthly reports, and your account manager will
show you how to access volumes of information and report-producing
tools on our client portal, which stores all of your claims data.
Before Medical Episode
During Inpatient Stay
After Patient Discharge
• L
everage extensive bulk buying power
to deliver the most competitive
provider reimbursement rates
• A
ggressively manage the stay
through regular and frequent contact
with hospital case management
staff and medical director, as well
as attending physician peer-to-peer
interactions that:
• Bill review:
- Coordinate care
- Claim receipt from provider
- Majority of contracts are fixed
case rates
- Prevent over-utilization
- Fraud identification
- Enhance health outcomes
- Duplicate tracking
- Industry-leading savings
- Facilitate medical best practices
• Reserve/cost estimate protocols
- Reduce health care costs
- Verification of medical
service provision
• 1 00% discount security (HIPAA
and managed care compliance
protocols)
• Maintain electronic record
throughout inpatient stay
• Patient direction to credentialed
high-discount providers
- Hygeia Network and UnitedHealth
Access Network
• C
omprehensive provider referral
tools, available 24/7/365
• P
rovider quality and cost comparison
reports by region or city to facilitate
patient direction to low net-cost
providers
- Bill code editing
- Charge analysis and benchmarking
- Bill auditing
• Claim administration and re-pricing:
• Subrogation (where applicable)
• C
are coordination program fully
accredited by the Utilization Review
Accreditation Commission (URAC) To learn more contact us at 866.527.0549, email [email protected], or visit us at www.uhgi.com.
Expert Viewpoint. Global Perspective.
Cross Border SolutionsTM is a business of UnitedHealthcare
International, a division of UnitedHealth Group, one of the largest
and most diverse health care companies in the United States, which
develops innovative solutions that address local and global health
benefit needs by applying proven expertise and experience.
UnitedHealthcare International’s core lines of business include:
Embedded in local culture and equipped with industry-leading
knowledge and perspective on the worldwide health care market,
UnitedHealthcare International provides solutions for all consumers
of domestic or cross-border health care management, insurance
and administration services, regardless of their geographic location,
language or cultural origins.
• Global Solutions: Seamless, quality, worldwide health insurance
coverage solutions for expatriate employees of U.S.-based companies.
• Cross Border Solutions: Access to UnitedHealthcare’s U.S.
networks for international insurers, government entities, third party
administrators, assistance companies, self-funded plans, claims
handlers and expatriate programs with clients traveling to the U.S.
• U.S. Benefits: UnitedHealthcare coverage for U.S. employees of
foreign-based companies.
• F
oreign/Domestic: Health care benefits administration for insurance
companies and large employers in certain countries around the world.
Together, these businesses provide simple, affordable health access
and employee benefits for individuals across the globe.
It’s a world of solutions – within your reach.
To learn more contact us at 866.527.0549, email [email protected],
or visit us at www.uhgi.com.