A patient in California recently spent two days in the hospital for a femur fracture. For the stay of two days in a standard medical-surgical bed, and the operating room used during surgery, the hospital charged $343,636. Reasonable pricing, however, including a profit for the hospitals, was only 13% of that-$43,830.
Medical overbilling like this costs unions’ health plans, self-funded employers, and administrators billions of dollars every year. WellRithms helps prevent those losses by reviewing medical bills, repricing them fairly, and guaranteeing the savings.
WellRithms offers a comprehensive solution for union and employer health plans looking to stop overpaying for healthcare services. The company’s solutions for out-of-network repricing, inpatient itemized bill review, and in-network review are designed to help these groups and patients get the most accurate pricing for that care.
The company also offers Workers’ Compensation solutions. Its medical bill review technology delivers a comprehensive suite of solutions that augment existing bill review services to improve cost containment outcomes, while ensuring providers are paid accurately.
Founder Dr. Merrit Quarum explains how he was inspired to create the WellRithms model:
“In 1989 I began working on transforming healthcare reimbursement, with a vision of a model that is sustainable, transparent, and fair for payors, patients, and providers.
“Some years later I wrote a book about the healthcare industry, called ‘Stop Paying the Crooks’ based on my witnessing the disconnects between patients, payors, and provider. I was observing how changing legislation, provider consolidation, private equity incentives, and distorted insurance markets allowed hospitals and physicians to dramatically inflate their charges, knowing that secretly negotiated discounts eventually would settle any claim.
“Meanwhile the cost of healthcare was escalating to unsustainable levels, as unethical and opaque business models ruined countless lives physically and financially. So we’re fighting simply for fairness and justice in healthcare billing. It’s what drives us.”
Using an advanced software program WellRithms reviews medical bills on a line-item basis, and then has surgeons and medical doctors review the items that the software red-flags. After catching unjustified charges, the company reprices the bill to a fair payment level and tells the union plan how much they should really pay, before they make the payment. The company has clients, including one in the labor world, who it has helped save more than $5 million a year in unfair billing.
That is not where WellRithms’ dedication and services end.
WellRithms will even indemnify select bills by taking over the risk of the entire billed charge and paying any adverse judgment or fines. This service, Shield Indemnification™, acts as a shock absorber, ensuring that patients will not be forced to absorb the shock of an unjustified balance bill amount or pursued by collection agencies.
WellRithms will defend its findings in court, if necessary. The company provides its own legal counsel, expert witness testimony, and exhibits.
As a practicing surgeon for more than 40 years and owner of a successful surgery center, WellRithms Chief Medical Officer Ira Weintraub, M.D., emphasized the company’s commitment to fair pricing. “It’s essential to distinguish between legitimate costs and those inflated beyond reason. When we come across a medication marked up to 53 times its cost, we challenge these charges. Our goal is to ensure that bills reflect genuine charges plus a fair profit, not opportunistic overpricing.”
Kevin Renner, WellRithms Executive Vice President of Marketing, has worked across health care systems, insurers, and technology companies for most of his career. “Every day about 650 Americans are driven by medical debt into personal bankruptcy,” he observes, “and much of that debt is due to error-prone, abusive, and fraudulent medical billing.
“Some of these victims are overcharged by thousands of dollars, and sometimes it’s in the hundreds of thousands of dollars or more. Many people see their life savings depleted. And they have no idea that much of what they are charged is mistake-ridden or deliberately inflated. There’s just a shocking amount of injustice in what’s going on, and an enormous transfer of wealth in the billions of dollars to unscrupulous providers.”
