Addressing Out of Network Claims

One of the biggest cost factors that occur in medical negotiations are out of network claims. The NostraData team has significant experience in dealing with these charges and negotiating a fair settlement between providers and payors/plans. Various sources place the level of out of network claims in the United States at 8-12% of total medical expenditures totaling over $250 billion annually.

The most insidious aspect of the out of network claims process is the financial burden placed on patients through a practice called balance billing. News headlines publicized patients facing outrageous charges that came as a surprise after receiving emergency care in a hospital setting. Nearly all patients claimed they thought these charges were covered by insurance.

Among people with employer coverage, nearly one in five inpatient admissions includes a claim from an out-of-network provider