Stop-Loss Pioneer and Foundational Leader of USBenefits USBenefits Insurance Services honors the life and legacy of George Kadonada, a pioneer of the self-funded and stop-loss industry and a foundational figure of our organization. George’s career helped shape the...

Healthcare costs continue to rise, and for many self-funded Plans, high-dollar claims can pose a serious financial risk. When faced with six-figure hospital bills, Plans and third-party administrators (TPAs) must balance their fiduciary responsibility to control costs...

When selecting a stop-loss provider, it is essential to ensure that the TPA (Third Party Administrator), plan, and stop-loss carrier are aligned in their approach to cost containment. The primary purpose of purchasing stop-loss insurance is to protect the plan from...

HELP… it’s becoming less of a request. More often than not, we see our producers feeling that they must undertake situations alone without collaboration. At USBenefits, our partnerships are important to us. We invite your requests and we’ll do our best to jump through...

What do you think of when you read or hear the word “Claims”?  Universally, the Claims department (Claims) is perceived to have given the insurance industry a black eye. Even within the industry, Claims frequently find themselves in the hot seat – often through no...

Artificial Intelligence (AI)…  The phrase and concept that transitioned from predictive modelling (inclusive of loss rating / experience models) of yesteryear to The Terminatorof tomorrow. While the debate continues as to the value, predictability and credibility of...

The following article was featured in the Summer 2022 issue of BC Advantage magazine but still has tremendous relevance today. We feel it is very worthy of a second look and warrants redistribution as the market is experiencing a breach in aggregate coverage, which...

In healthcare, a doctor’s priority is to provide the best care for a patient. However, this can sometimes mean deviating from our industry’s processes and regulations. One such process is pre-certification, also known as prior authorization, which may be required by...

USBenefits can assist you and fully insured clients to consider if stop loss is appropriate for their needs. To help us properly and expeditiously review your RFP, all fully insured submissions are subject to the following in addition to our underwriting guidelines....

By Mike Lanza In our industry, there is much hesitancy to review in-network claims for billing errors and unnecessary treatment. One concern is that an audit will take too much time and may violate prompt pay rules, but that concern should not prevent a detailed audit...