Abstract: A method and business technique for reviewing medical service provider bills, recalculating and providing payment recommendation to a paying party for the bills. The method includes analyzing medical bills and determining erroneous and inappropriate charges on bills. The method provides a payment recommendation using multiple databases and sophisticated mathematical modeling that includes one or more of the following: a medical service provider's actual cost of delivering the medical services provided; the average profit-margin of that provider, an average profit margin of comparable medical providers in an area, other industry-specific profit-margin benchmarks; an average acceptable payment by medical service providers in the area for comparable services; payment rates negotiated by large health insurers and managed care organizations; and other industry benchmarks for reasonable payment for comparable services.

Abstract: A method and business technique for reviewing medical service provider bills, recalculating and providing payment recommendation to a paying party for the bills. The method includes analyzing medical bills and determining erroneous and inappropriate charges on bills. The method provides a payment recommendation using multiple databases and sophisticated mathematical modeling that includes one or more of the following: a medical service provider's actual cost of delivering the medical services provided; the average profit-margin of that provider, an average profit margin of comparable medical providers in an area, other industry-specific profit-margin benchmarks; an average acceptable payment by medical service providers in the area for comparable services; payment rates negotiated by large health insurers and managed care organizations; and other industry benchmarks for reasonable payment for comparable services.

Abstract: A self-insured or self funded medical benefit plan is provided by an employer wherein the self-insured medical benefit plan is governed by ERISA, and wherein the employer who is providing the medical benefit plan is 100 percent responsible for payment for medical services provided to an employee, receiving the benefit of the medical benefit plan, to a medical service provider for covered medical services and products. The medical benefit plan and method for providing the medical benefit plan determines a reasonable value for the medical services provided by a medical service provider to a participant of the plan, reprices a bill or claim from the medical service provider, and protects the participant/employee under ERISA from attempted collections of additional moneys that a medical service provider may believe is owed for the medical services but were not paid by the exemplary self insured medical benefit plan.

Abstract: A self-insured or self funded medical benefit plan is provided by an employer wherein the self-insured medical benefit plan is governed by ERISA, and wherein the employer who is providing the medical benefit plan is 100 percent responsible for payment for medical services provided to an employee, receiving the benefit of the medical benefit plan, to a medical service provider for covered medical services and products. The medical benefit plan and method for providing the medical benefit plan determines a reasonable value for the medical services provided by a medical service provider to a participant of the plan, reprices a bill or claim from the medical service provider, and protects the participant/employee under ERISA from attempted collections of additional moneys that a medical service provider may believe is owed for the medical services but were not paid by the exemplary self insured medical benefit plan.