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...

At USBenefits, we believe the goal of cost containment is to ensure the Plan is not paying for any services that are excluded according to the Plan document. This means not only looking for billing errors, but also treatment misadventures that could cost the Plan tens...

What’s the most important aspect of shopping for stop-loss insurance? The first response is usually the lowest price, and maybe a distant second is name recognition. However, you rarely hear claim handling even being mentioned. So why is that? Probably because no one...

With inflation at 40-year highs for almost a year now, and the Federal Reserve raising interest rates to combat inflation, there are predictions of a recession in 2023/2024. What can a Self-Insured Plan do to keep medical costs down to retain employees during the...

In a recent discussion with employers, most knew they had Stop-Loss coverage for their self-funded medical plan. They further understood that it’s protection from a large loss. However, there was some confusion as to the role and relationship between the Claims...

A natural and healthy conflict exists between underwriting and sales. It's easier to manage when the underwriting and sales (producers) are separate entities. However, many stop-loss carriers/MGUs (carriers) compensate their sales (marketing) staff in a similar manner...

What is a ‘Trusted Advisor,’ and why is this important to you? There are several references on what a trusted advisor is. Simply put, it is a person and company that does not act only as a facilitator to your inquiries or needs. A trusted advisor will offer an...

At USBenefits Insurance Services we take pride in our ability to identify potential claim issues to ensure the Plan is not paying for items that should not have been billed by the provider. In our most recent example, the claimant was undergoing chemotherapy over many...

(Part 4 of 4) Are you using Automated Clearing House (ACH) to make and receive payments? ACH is an electronic application that allows the direct transfer of funds between two bank accounts with several benefits to all parties. Preferred method: Usage of paper checks...