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Services - Claims Tracking and Reimbursement

We don’t end upon placement of coverage. We provide all clients with ongoing claims tracking and reimbursement support in a secure email and file retention environment.  

 

Our setup removes any concerns about timely reimbursement when placing stop loss or reinsurance outside of your health plan or TPA.

 

Actions provided by our experienced claims support solution includes:

 

  • Ensure timely receipt of monthly high claimant reports from all health plan administrators, per stop loss policy coverage specifications and reporting requirements.

 

  • Obtain claimant eligibility data in support of claim filings.

 

  • Process the initial and all ongoing claims in a rapid and efficient manner.

 

  • Serve as intermediary between stop loss carrier and health plan in pursuit of an expedited reimbursement. We leverage our knowledge and relationships with both parties to achieve a quick, “hassle-free” reimbursement of our client’s expense.

 

  • Pursue any third-party PBM pharmacy claim reports – a process often overlooked by many stop loss policyholders (and their advisors), even when pharmacy is a covered stop loss expense. This “additional” expense frequently accounts for as much as 25% of a high claimant’s expense. High-cost specialty drugs may further create claimants who exceed stop loss deductibles solely on pharmacy expense alone.

 

Armed with our claims support, stop loss coverage external to your health plan or third party administrator offers both peace-of-mind and great value.

 

Contact us today to discuss our approach, market observations, and to obtain a No-Commitment review of your coverage.