The intricate dance between case managers, benefits consultants, and health care providers is often marred by communication disconnects, leading to fragmented patient care and costly insurance reimbursement denials. According to a recent Kaiser Family Foundation (KFF) study of Affordable Care Act (ACA) plans, companies denied an average of 17% of claims in 2021, with one insurer astonishingly rejecting 49% of claims. This is not an anomaly — the number of health care claims denied is staggering. Many are primarily due to communication and coordination issues, and the current solutions in place fall short of addressing this critical issue.
The root cause of this widespread denial and care fragmentation lies in the breakdown of communication channels between these entities. Delayed updates, uncoordinated inquiries, and disjointed discharge requirements contribute to a chaotic health care environment, impacting patient outcomes and burdening the industry with excessive costs. Despite being vital players in the continuum of care, communication barriers often hinder collaboration between case managers, benefits consultants, and providers, resulting in claim denials and increased financial strain on health care organizations.
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