At USBenefits, your goal is our goal – to provide the best possible outcome for the employer. Not only do we have over 35 years of experience in claim payment and review, but also the expertise and contacts to help TPAs and Plan sponsors navigate what can be a very complicated industry.
In part-three of our inaugural Claim Success series, we’re sharing another recent success story achieved by our claims team.
When a provider threatened to sue its Plan over a reduction in payment based on Reference Based Pricing (RBP), the broker contacted USBenefits. A claim was never filed with USB, so the broker was concerned that if the Plan had to pay additional money, there would be no opportunity for the Plan to file a stop loss claim, considering the Plan’s stop loss policy had expired.
USB referred the claim to its ERISA attorney for review. After careful examination of the Plan provisions, USB’s attorney contacted the hospital, pointing out that the Plan Document was very clear on how it reimbursed providers and provided the Plan appeal guidelines.
After numerous follow up attempts by the USB attorney with the hospital, no response was received, and the case was closed – saving the Plan almost $400,000.
Does your stop-loss partner have the expertise and contacts that will ultimately save you money? Be sure to subscribe to our emails and follow us on LinkedIn so you don’t miss out on our next Claim Success story.