Have you ever had a claim you knew was excessive but you could not reach an agreement with the provider? StrataGEM provides fair and compliant options where traditionally none were available.

How does it work?

This option is suitable in special circumstances where all other options have been exhausted through our GEMDeal services and the provider remains unwilling to consider reasonable payment terms. In these situations, we assist our clients so that they remain in control of their claims decisions. We do this by proving claim-specific reports containing relevant information based on objective data. Along with this report, we provide you a detailed explanation of benefits that can be sent to the provider with an appropriate payment. For this option to be suitable, some pre-requisites must be met to ensure that we will be able to work with the provider and reach a permanent resolution of the claim. From start to finish, our clients are in control.

What about the member? I want to pay a fair rate, but I do not want noise from my clients.

At Global Excel, we take the protection of the member seriously; sacrificing customer experience for savings is not an option. As a result, we have developed a patient advocacy program to ensure our clients meet their customers’ expectations while also helping them pay a fair amount to providers.

How long does it take and is there a minimum dollar threshold?

This option is successful because it is flexible. We consider the circumstances of each claim and adapt our approach accordingly. Though many cases settle within weeks of the payment, patience during this process often yields the best results. This product uses a number of expert resources and its suitability is evaluated based on a number of criteria, including the size of the claim.

The timeline may cause me some issues with my medical excess carrier; what do you do in these situations?

We likely already work with your medical excess carrier, and in our experience most carriers are willing to extend deadlines to ensure that claims are paid appropriately thereby creating a win-win for all parties including the plan, the carrier and the administrator.

How is GEM different from other UCR vendors?

We evaluate each claim and adapt our approach accordingly. We also ensure that other options have been exhausted and we support our client’ decisions which appropriate data and experience. The bottom line is that this solution helps our clients meet their customers’ expectations while also helping them pay a fair amount to providers.