Highlight Health is a well-known resource to the stop-loss insurance industry.
Stop-loss carriers (insurers, captives, and reinsurers) are the backstop to self-funded employers in the United States, and Highlight Health recognizes the unique role they serve. Highlight Health serves the stop-loss industry and is attentive to stop-loss issues, including the recent tremendous growth in multi-million dollar stop loss-breaches. The breaches almost always involve very large (jumbo) hospital claims. We are particularly expert at reducing costs for hospital claims.
Prior to 2021, there were little resources available to stop-loss carriers to help them ensure large claim payment integrity and properly contain costs. This changed with the passage of the Consolidated Appropriations Act of 2021 (CAA) and the advent of price transparency. The new legal environment is particularly powerful when stop-loss carriers and plans work together.
Our experts love working on jumbo claims! These types of claims are often messy, complicated, and unique to the circumstances involved. We have had outstanding success in reducing the cost of jumbo claims, saving costs for the stop-loss carrier, their reinsurers, and the plan. We can sometimes prevent a large stop-loss rate increase and/or a participant from being lasered.
Highlight Health provides our stop-loss insurer clients with a better strategy for managing claims for participants who breach stop-loss.
- We enhance our clients’ ability to identify and track high dollar participants before they breach.
- We look beyond the claims themselves to comprehensively check for every cost-saving opportunity. For example, we verify that the patient was properly covered.
- We carefully explain our repricing, and the legal basis, to the stop-loss carrier and the plan, with support and citations.
- We manage communications and any objections by the hospitals, and advocate for our clients.
- We obtain substantial savings for our clients’ bottom line and spare plans rate increases and lasers.
New stop-loss carrier clients often ask why we request more data and information than our competitors. They, however, soon realize the additional data and information is necessary to our comprehensive analysis, an analysis that often produces additional savings.
Highlight Health also works with its stop-loss insurer clients to underwrite and design plans differently to win new business.
- Our results allow stop-loss insurers to underwrite plan sponsors aggressively and with confidence.
- We recommend that plans adopt specific plan document language that further enables our work.
- We leverage creative service agreements and plan design strategies to align stop-loss interests with both plans and their participants.