FAQ

Questions & Answers

Questions About Reliant

About Reliant’s Open-Access Network Alternative

  • Reliant Health Partners is a medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client’s needs, providing everything from full plan replacement as an open-access network alternative, to individual specialty claims repricing, to OON wrap coverage and worker’s comp savings.

  • For group health, we get stronger discounts than a PPO and similar discounts to a Reference-Based Pricing (RBP) plan. But you’ll see much less noise, and a much better member experience. So instead of hoping your network doesn’t raise prices again, you can achieve deep, consistent savings, with the member freedom of an open-access model.

    For casualty, our discounts consistently fill coverage gaps and in most cases outperform network alternatives.

  • We’ve developed our own balanced, strategic claims repricing methodology, in addition to offering traditional RBP repricing. The Reliant model is far more effective than the PPO network pricing model, and in most cases more effective than RBP. Reliant’s unique approach references an ever-growing number of private and public data points, including a proprietary database of provider reimbursement data, which we’ve been building since 2010. We proactively determine what's appropriate and fair for all parties before making our final reimbursement recommendation. That's how we combine deep savings with industry-leading acceptance rates.

    In short, we consistently take steps nobody else on the market does, to get results nobody else can.

  • Over 99% of our repriced claims are accepted, due to our leveraged proprietary database and balanced approach. But in the rare event of an appeal, we defend recommended payments with robust documentation, and facilitate an agreement that works for all parties. And 70% of appealed claims are resolved based on our original pricing recommendation.

  • Each client has a dedicated account manager to handle day-to-day questions, reporting, and other support. We also have a team dedicated to providing provider access support and appeals resolution.

  • Yes, we work with PPOs to eliminate gaps in coverage and capture additional savings they can’t reach. So you can easily leverage Reliant for health plan Out-of-Network and Casualty claims, without throwing out a network you already like. But we can also serve as a standalone high-performance network alternative! Tap us first for the deepest and most comprehensive health plan savings, with the least noise. You may find you don’t need to be tied down to a true network at all.

  • We offer a 48-hour turnaround guarantee from the time each claim is submitted as our standard. However, if you need a faster turnaround, we can certainly accommodate those requirements.

    In the very unlikely (<1%) event of any appeals or balance billing, we quickly turn those around in-house too, negotiating an agreement that works for all parties, with no additional work from you or your clients. Contact us to see if we can accommodate any special timing requests.

  • We have broad and comprehensive communication and reporting capabilities, and work with you to tailor an approach that’s appropriate for your needs. Our dedicated account management and appeals team will keep you updated according to the schedule you choose.

  • We have comprehensive, HIPAA-compliant privacy and security protocols in place, including secure data transfers at every step.

Questions For Employers

Group Health Claims Repricing

  • We save employer health plans a substantial amount. For Plan Replacement, our discounts off of billed amounts are generally 60-75%, resulting in 20-35% off of planned spend. For Out-of-Network, our discounts are typically as good as in-network discounts and often better. Schedule a consultation or contact us to see what we could deliver in your unique situation.

  • Reliant’s services are based on an open-network model, meaning your members have the freedom to go to any doctor, hospital, or medical facility they choose – even for specialty services – without referrals. If a particular provider is unfamiliar with our model, our member advocate will resolve any access issues to ensure the member gets the care they need.

  • In some cases, we’ll resolve individual access issues with a single-case agreement, for a specialty service with a particular provider. We handle the negotiation for you, so you don’t have to bounce it back to your network partner and sacrifice savings.

    Other times, what you need may be a “narrow network” to provide full PPO replacement. In those cases, we can negotiate a contract in advance with a major regional hospital system, so members have no out-of-pocket expenses in that “safe haven.” And our member advocates are always available to liaise for members if any access issues do arise.

  • Yes, when you partner with Reliant, you automatically receive our comprehensive access and appeal services. Because our methodology is so proactive and balanced, fewer than 1% of claims we reprice ever get pushback. But when it does happen, our appeals department defends recommended payments with robust documentation, and facilitates an agreement that works for all parties. There’s no additional work involved for employers or members.

  • Yes. Reliant works with many TPAs across the country. We can easily integrate with your existing TPA, or recommend one of our preferred TPA relationships. We also have many preferred relationships with Stop-Loss carriers, medical management, PBMs, and concierge vendors servicing self-funded employer health plans.

  • No. We do business in all 50 states and can work with any industry employer, union, Taft Hartley program, or association that is a self-funded health plan.

Questions For Members

Group Health Claims Repricing

  • This type of plan allows your employer to manage the ballooning cost of healthcare, while continuing to provide quality benefits to you and your family. You get even better access to the care you need, at a lower cost than with a network, and with a better member experience.

  • When your health plan eliminates a Preferred Provider Organization (PPO) network, you can access any provider you choose. In the case of Reliant Health Partners’ (RHP) network alternative, your employer will pay a fair price for any provider that you select. Access the care you need from the provider you want, even for specialty services!

  • Since Reliant is not a network, no provider is in-network or out-of-network for members. You have the freedom to go to any doctor, hospital, or medical facility you choose. Just show your plan ID card to the front staff, and tell them you have an open-access plan.

  • Tell your provider you have an open-access plan. They should collect any applicable deductible and co-pay, and submit a claim through the plan’s Third-Party Administrator (TPA). If the provider has questions, have them call your TPA immediately at the number on your ID card.

  • Do not pay anything other than your deductible and co-pay up front. Have the front desk call your plan’s Third-Party Administrator (TPA) at the number on your ID card with any questions.

  • After any medical service, you will receive an Explanation of Benefits (EOB) from your plan’s Third-Party Administrator (TPA). The EOB is a breakdown of what medical treatments were billed, what benefits were paid, and what you, the patient, are responsible for paying.

  • Providers send members a “balance bill” when the health plan won’t pay the provider’s entire invoice. For example: if a hospital bills your health plan for $1,000, and the plan only covers $450, then the provider bills you the remaining $550 balance under “patient responsibility.”

  • Compare it to your Explanation of Benefits (EOB) for the service provided to see if you’re being asked to pay more than what’s listed on your EOB. If so, call your Third-Party Administrator (TPA) immediately at the number on your ID card.

Casualty Claims Repricing

  • Please contact us for a customized savings analysis based on your historical claims.

  • Our ability to achieve savings in your state(s) is impacted by state-mandated fee schedules. Please contact us for a customized savings analysis based on your historical claims.

  • This is where you want an overachiever in your corner. We can often find deeper discounts on a casualty claim that someone else has already repriced due to our proprietary database of provider reimbursements. The Reliant model leaves no stone unturned!

  • No problem. Each state will have its own unique hurdles and limitations. But we can get surprisingly deep discounts on casualty claims in almost any state, whether they use a fee schedule or not.

  • Do not pay anything other than your deductible and co-pay up front. Have the front desk call your plan’s Third-Party Administrator (TPA) at the number on your ID card with any questions.

  • Yes, we work with bill review companies and all types of networks to eliminate gaps in coverage and capture savings they can’t access themselves. However, we think you’ll find your best option is to use Reliant as a standalone high-performance network alternative! Tap us first for the deepest and most comprehensive savings, with the least noise. You may find you don’t need to be tied down to a true network at all.

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