When signing up for a health plan, it is important to thoroughly review and understand the contract you are entering into. One key aspect to look out for is the IFNE – complications.

In this article, we will discuss what IFNE means and how it relates to potential complications.

What is IFNE?

IFNE stands for Inpatient Full Net Equalization, which is a method used by health insurance plans to determine the amount of payment for services received during an inpatient hospital stay.

Essentially, IFNE attempts to balance out the discrepancies in pricing between different hospitals and healthcare providers.

Complications and IFNE

One important thing to note is that complications during an inpatient hospital stay can have an impact on the IFNE calculation. In general, complications increase the cost of care, which can result in higher payments from the insurance plan.

Types of Complications

There are two main types of complications that can occur during an inpatient hospital stay:.

Medical Complications: These are complications that arise from a patient’s medical condition. For example, a patient with diabetes may experience an infection that requires additional treatment. Medical complications are typically covered by insurance plans, but they can increase the overall cost of care.
Procedural Complications: These are complications that arise from a medical procedure or treatment. For example, a patient undergoing surgery may experience bleeding that requires additional treatment. Procedural complications may or may not be covered by insurance, depending on the specific plan and circumstances.

Impact on Payment

Complications can have a significant impact on the payment received by hospitals and healthcare providers. With IFNE, the payment for an inpatient stay is based on the cost of care for a “typical” patient with the same diagnosis.

However, if a patient experiences complications, the cost of care will likely be higher, which means the payment from the insurance plan will also be higher.

Appealing IFNE Payment

If you feel that the IFNE payment for your inpatient stay is incorrect, you may be able to appeal the decision. This typically involves providing additional documentation and evidence to support your claim.

It is important to note, however, that appealing an IFNE payment can be a complex and time-consuming process.

Conclusion

Understanding your health contract is essential to ensuring that you receive the care and coverage you need.

When reviewing your contract, be sure to pay attention to the IFNE – complications clause and how it may impact your payment during an inpatient hospital stay.