healthdecisions.com

What It Is

Health Decisions, Inc. is a Michigan-based U.S. company founded in 1985. Its customers are mainly self-funded employers, trusts, plan fiduciaries, health payers, TPAs, consultants/brokers, and internal audit and finance teams. Strictly speaking, it is not a typical self-service SaaS platform; it is closer to a group health benefits auditing and cost-containment provider driven by technology and expert review.

Core Features and Service Capabilities

Its core modules include medical claims auditing, recovery and Routine Plan Monitoring, as well as Dependent Eligibility Verification. The claims audit service emphasizes reviewing 100% of paid claims rather than using samples, covering more than 40 audit categories, including provider payments, coordination of benefits, and cost sharing. RPM monitors more than 50 client-approved service standards each month, quickly flags claims payment errors, and tracks improvements through quarterly overpayment audits and year-round reporting. For dependent eligibility verification, the website states that it identifies an average of 6% ineligible dependents, achieves an average overall response rate of 97%, and offers a response-rate guarantee.

Pricing, Security, and Support

The website does not publish standard plans or pricing. Its FAQ clearly states that fees are not based on a percentage of savings or the number of dependents removed, and projects typically require an RFP or contact with sales for confirmation. A Dependent Eligibility Audit usually lasts around 4 months and can be customized around the client’s objectives. Security and compliance are major selling points: the company states that it is fully compliant with HIPAA and HITECH, is bound by HIPAA Privacy and Security Rules as a Business Associate, trains its employees, and stores sensitive files in a separate, locked, access-restricted HIPAA-secure environment. Support hours are Monday to Friday, 9:00–17:00 U.S. Eastern Time, and the call center can provide Spanish support as well as real-time interpretation via Language Line.

Pros and Cons

Its strengths include long operating history, full-claim coverage, the ability to accept data in any format, and an emphasis on reducing costs without changing the client’s existing processes. Customer testimonials also highlight its project management, communication, and high-touch service capabilities. The main limitation is the lack of SaaS-related information: there is no visible detail on APIs, third-party integrations, permission systems, self-service dashboards, cloud deployment, or self-hosting. Pricing is also not transparent, and the buying process is closer to an enterprise services engagement.

Who It’s For and Access from China

It is best suited to mid-sized and large organizations in the U.S. market that have self-funded health plans and need claims recovery, dependent eligibility verification, or compliance auditing. For Chinese companies without U.S. employee benefits plans or HIPAA-related scenarios, the fit is limited. The website does not disclose access from China, payment methods, or local alternatives, and network availability is marked as unknown. Domestic users in China may want to prioritize local providers focused on medical insurance cost control, commercial insurance claims risk management, employee benefits, and TPA-related services.