Field notes · The chain
Five incentive lines in your claims chain. Follow them.
Five parties touch your claim. Count who earns more when the invoice grows.
One question exposes the whole chain.
Follow the money through your own chain
Every party between you and the Egyptian bedside is rational. Each one responds to how it is paid, not to how you wish it behaved. Lay the incentives side by side and your loss ratio stops being a mystery.
| Actor | How they earn | What grows their income | Effect on your invoice |
|---|---|---|---|
| Hospital | Margin on every line | Bigger files, longer stays | Grows it |
| Assistance company | Fee per case handled | Smooth, fast case flow | Neutral on size, allergic to friction |
| TPA / cost container | Percentage of invoice volume, or of "savings" off asking price | High asking prices | Blesses it |
| Network | Access fees plus negotiated "discounts" | Inflated list prices to discount from | Legitimises it |
| Independent reviewer, share of reduction | A share of what is removed from the bill | Your invoice falling | Shrinks it |
The alignment test
One question, asked of every partner in the chain: "What happens to your revenue if this invoice falls by half?" The hospital loses. The volume-paid TPA loses. The discount network loses its headline. The assistance company shrugs. Only a reviewer paid on reduction gains exactly when you gain. Incentives are not a moral judgement; they are physics. Build your chain so at least one actor's income points the same direction as your loss ratio.
You do not need everyone in the chain on your side. You need one party whose income falls to zero unless your invoice falls. That is what alignment means in practice.
Why this matters more in Egypt than anywhere
In a market with published tariffs and enforceable fee schedules, misaligned incentives leak slowly. On the Red Sea, where each invoice is priced against your own precedent file and repriced under inflation every season, misalignment compounds: every actor who profits from the asking price quietly ratifies next year's higher asking price. The chain does not conspire. It simply settles, and the settlement becomes your new floor.
The honest disclosure
I am the fifth row of that table, and you should apply the same test to me. My fee is a share of what I remove from the bill, never a percentage of the invoice. If the bill does not fall, I earn nothing. If I find nothing wrong, I tell you the invoice holds, in writing, and that costs you nothing too. There is no configuration of this arrangement in which I profit from your costs rising.
Ask each party what it earns when the invoice grows. Then add one reader whose interest is the bill falling.