Self-Funded Employers

Since 1985 Health Decisions, Inc. has been helping self-funded companies manage employee health benefits. Self-funded employers rely on Health Decision’s proven ability to save money - typically 2-3 percent of claim costs.
 

Health Decisions offers the most comprehensive and sophisticated Post Payment Claim Recovery Service in the industry. Nobody addresses more areas of claim recovery or recovers more money per client than we do. In addition, we will develop customized recovery applications requested by the client at no additional cost.
 
Health Decisions goes much deeper seeking claims to recover by conducting a review of 100 percent of claims in more than 25 areas to identify and recover claims paid that are not the employer’s responsibility.
 
Many employers suspect that greater savings can be generated through aggressive claims administration, including coordination of benefits, but few are even aware of the potential for even more savings through aggressive eligibility administration.
 
Beyond providing opportunities for claim savings, the Health Decision review offers employers the most comprehensive and affordable approach to claim auditing available.
 
Our audit capabilities extend to the reconciliation and verification of enrollment information. Health Decisions assumes the technical and tedious aspects associated with enrollment reviews which gives employers the ability to address claims recovery management without disrupting current staff assignments.
 
Our proven claim auditing process includes use of Health Decision’s specialized staff to conduct a complete Enrollment Verification Survey of all covered persons with the full range of information needed for claim administration and regulatory compliance.
 
Health Decisions also gives employers direct access to claims, enrollment, and all other plan data in easy-to-use Microsoft or web-compatible formats.
 
All of our services allow employers to document in a tangible manner their fiduciary responsibilities and provides a means for employers to satisfy HIPAA requirements.
 
Companies ranging in size from one site with 100 employees to multi-site corporations with thousands of employees have discovered that Health Decisions provides the technical expertise that will help control benefit costs.

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“Health Decisions is currently performing our first ever claims review with Aetna. They successfully navigated all of Aetna’s requirements on a timely and professional basis. The Museum expects a very good outcome from the audit, and we will be happy to use Health Decisions again.”


Michael Malesardi
VP and Controller
Presidio Inc.

“It was Health Decisions’ experience in conducting these types of audits that differentiated them from other companies we looked at. The Health Decisions staff was responsive and knowledgeable and I was satisfied with the project. A key benefit of their audit is the knowledge going forward that the data is clean – we cleaned up our rolls. I would recommend Health Decisions to other employers.”


Brett Green
Director Total Compensation & Wellness
Wayne State University

“The Health Decisions team was wonderful. They did a thorough job, and they were ahead of the game, anticipating the next move in each situation. Staff was most helpful… doing whatever was necessary to put a wrap on the project.”


Jane Starnes
Human Resource Specialist
Road Commission of Oakland County

“The Health Decisions audit staff made the project a positive experience. They were timely, and did a good job of keeping the project moving forward. I would highly recommend Health Decisions to conduct the Dependent Audit.”


Nancy Kusko
Director Benefits Administration
Pittsburgh Public Schools

“I would very much recommend Health Decisions. It’s a good organization to partner with. They are very experienced, knowing what issues the employees are going to have, and anticipating those issues. Our experience with the Health Decisions staff was very positive – they were very helpful in explaining the process and proactive in communicating to help us make this the best possible experience for our employees.”


Jeff Knapp
Director, Benefits
Grubb & Ellis Company

“Without a doubt, this was a very worthwhile endeavor. The audit was a very painless project, and very much worth the expenditure of monies. You can do it successfully and still be minimally involved, if you choose. The Health Decisions staff is terrific – a true joy to work with. We would not hesitate to use Health Decisions again in the future.”


Tim Bieber
Human Resources Manager
District Photo Inc.

“I would recommend Health Decisions. Our experience was very positive, and the process was managed very effectively, ensuring that we stayed on task. The audit was completed even earlier than planned and confirmed that our [internal] procedures are effective.”


Christine Kujawa
Vice President, Human Resources
ITC Holdings Corp.

“The Health Decisions team is not afraid to get in there and make sure that the carrier does what they’re supposed to do; and [Health Decisions] has all the facts and all the knowledge to back them up. I would recommend Health Decisions – they did a great job. Even if you think that your carrier is paying everything they’re supposed to be paying, you still need that validation from a third party that the plan is being followed the way it’s supposed to be followed. Take that step to do the audit – make it a part of your compliance plan.”


Mark Lohman
Corporate Benefits Manager
La-Z-Boy Incorporated

“We had a very positive experience with the Health Decisions Audit Team – very professional, very responsive, they stuck by the timelines, and stood by the process and fee that was set out initially. [The team] was extremely knowledgeable about the benefits audit process and how that tied into our objectives.”


Michael Malesardi
VP and Controller
Presidio Inc.

“I would recommend Health Decisions. The process worked very well, they were very thorough, and very good to work with. I certainly thought it was worthwhile.”


Joni Johnson
Deputy Director of Human Resources
Jackson County, Michigan

“I found the staff at Health Decisions to be very responsive. We didn’t have any issues, and the audit experience was very smooth. Anyone looking for an audit firm should take a look at Health Decisions.”


Elizabeth Schuster
Human Resource Manager
Cummins Inc.

“I would highly recommend Health Decisions to anyone looking for this service. It was our first time through this major process, and it was a great experience. The audit went so much more smoothly than I ever thought it would.”


Jane Starnes
Human Resource Specialist
Road Commission of Oakland County

“Through Health Decisions’ continuous aggressive efforts, hundreds of thousands of dollars have been recovered and credited back, which reduces our utilization and ultimately stabilizes our rates. I would highly recommend Health Decisions if you have a cost savings concern.”


Paulette Poehlman
Risk Management Administrator
City of Pontiac

Check out the latest episode in our "Prudence Says" video series:

Prudence Says: Get READY to control your plan data!

 
409 Plymouth Road, Suite 220 • Plymouth, Michigan 48170
phone 734­.451.2230 • fax 734­.451.2835
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