ClaimTek Medical Billing Success Stories

Electronic medical claim processing is coming to the Philippines...

Gerome Vizmanos is showing hospitals and medical care providers in his native country how to bridge the gap (Pacific Ocean) with U.S. insurance companies that will have major ramifications on the Philippine healthcare system. Traditionally a cash-only system that precluded American expatriates from using their insurance, Philippine companies are now considering the electronic system that increases payment time from months to a week.

The impact is multi-fold -- Americans gain healthcare under their coverage. Philippine medical facilities will make more money to retain doctors and nurses now leaving for lucrative offers in the Middle East and United States. Increased funding will also expand medical care to Filipinos, especially those living in remote areas of the 7,107 islands that must travel a day or more to reach a clinic.

It's a win-win-win-win-win situation.

"I have an engine out there that's ready to take off," Vizmanos said. "My first mission is to help the Philippines to solve a problem, but since using ClaimTek's software and staff, there's no reason why it can't help other companies."

Vizmanos, 34, a Filipino national who grew up in California and earned an economics degree from DePaul University in Chicago, created the plan last year after his father died in the Philippines when unable to use U.S. health insurance covered by Stanford University where he worked 20 years.

"The hospital didn't know how to process insurance," Vizmanos said. "Their attitude was 'We're a private organization and not for charity.' It's a cash-basis system. You have a ton of U.S. citizens that want to retire in the Philippines, but their main concern is what happens to them in case of a medical emergency? Do they accept insurance? How much do these procedures cost?"

Vizmanos' Reliant Medical Claims Processing with offices in the Philippines and California acts as the middle man between health care providers and insurance companies. Currently, there is no one doing so. While Filipino companies may be cautious in a country with no insurance plans, higher payments should dissolve the distrust.

"We're trying to position ourselves to act as the guarantor [of payment]," Vizmanos said. "I can see why hospitals wouldn't even attempt it. It would take two weeks alone to get the invoice to America, but now with technologies everything can be done real time. You can submit everything electronically."

With a 13-hour time difference from the U.S. east coast and 16 hours from the west coast, Vizmanos said having offices in both countries will better resolve disputes or confusion over claims. And while 95.4 percent of 87 million Filipinos speak English, different coding systems must be hurdled. Vizmanos uses a voiceover IP computer program to communicate between countries without costly telephone charges.

"We can be that layer of translation for a different coding system," Vizmanos said.

Vizmanos' plan is modeled after the recent surge of medical transcription services provided for U.S. companies by Filipinos. One company grew from three to 50 employees in one year while another reached 100 within two years.

"It can get really big, really fast, Vizmanos said.

Of course, Vizmanos needed a software program and training to fuel his company. ClaimTek Systems (claimtek.com) was his choice after meeting with president Kyle Farhat. The software's ease is essential to satisfying a quick demand.

"Even someone not from the industry can understand the software and teach it to a staff," Vizmanos said. "The support from Kyle -- every benefit he sold with the software package has surpassed my expectations."

Vizmanos is also talking with Philippine government officials over the spillover benefits of electronic medical claims. For instance, it can increase "medical tourism" that is becoming increasingly popular in the Pacific rim. Many Americans are getting procedures for a fraction of the cost by American healthcare providers.

"The government will look at numbers. Companies like Kyle's will help," Vizmanos said. "Doctors in the U.S. who are Filipino descendants will approach the hospitals, too. It won't happen overnight."

But it's another step to going global.