The USBenefits claim department has, on average, over 35 years of experience in claim payment and review. This knowledge base, along with a team of the top cost containment vendors in the business, gives us the ability to control claim costs for our clients.
Below is a recent success story achieved by our claims team.
Working in partnership with its TPA, USBenefits was made aware of a very high cost COVID-19 claimant that had been in the hospital for several months. Since the TPA alerted USBenefits prior to the claim even being submitted to the TPA, the opportunity to impact the claim was greatly increased.
Upon notification, USBenefits immediately went to work to find the most appropriate vendor to review the claim – ultimately selecting a vendor that had a very successful track record reviewing and negotiating claims. The vendor then reached out to the hospital to begin the negotiation process. Since this vendor had the detailed cost data of the provider, they were able to:
- Quickly negotiate a signed agreement for a 56% discount on the billed charges
- Saving the Plan over $2.2 million dollars
USBenefits paid the vendor’s fee, so there was no additional cost to the Plan or TPA for the claim review or negotiation. Does your stop-loss partner go above and beyond to save you money?