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Who we serve > Plan Sponsors
See behind your largest claims. It's your right, and we make it easy.
A few high-dollar claims decide your year, and they get the least scrutiny before they're paid. We review them independently, before the money leaves the plan.
Book a CallYou know the numbers. You just can't see behind them.
Well under 1% of claims drive roughly a third of spend. One admission crosses the deductible, and nobody can tell you whether the price was ever examined.
Ask what's behind a large bill and you get a summary line, a network discount, and a wait. Ask again and you get "proprietary." By then it's paid.
The money is the plan's. For a trustee, it's the members'. For a public-sector plan, it’s the tax payers’. The plan sponsor is accountable for fiduciary oversight and the right help can make all the difference.
Where there's mystery, there's margin
The usual order
With independent review
Steps added by HLH, before the money leaves the plan
What a plan can't see, it can't question. What it can't question, it pays, and the system is built to keep it that way.
Independent review changes the order: the full file, examined before payment, by a reviewer that works for the plan and accepts no fees from the parties it reviews.
High-dollar claims stop being something you fund and start being something you approve.
The law is on your side. You just haven't been shown how to use it.
Your plan is entitled to its own claims data, including the negotiated rates behind every payment. Contracts that block it have been prohibited since 2020.
Hospitals must publish their prices. Nonprofit hospitals must also publish the financial assistance policies that limit what many patients can be charged.
The plan decides what it pays, and it's entitled to complete information first.
We put those rights to work, in the plan's name, on every claim we review.
What you get
A more predictable year
Large-claim exposure reviewed before it's paid, not explained after.
The plan's money stays in the plan
Every dollar identified before payment never left. No chasing, no recovery.
You can show your work
Every review produces a Documented Record: claim-level evidence of a prudent payment decision, ready when the board, the members, an auditor, or the Department of Labor asks.
A routine example
- Client
- A labor union health fund.
- The claims
- 12 large claims in one plan year, none above $220K.
- The review
- Contracts, published rates, and the hospitals' own financial assistance policies, claim by claim.
The result
$945K in network-allowed charges resolved to $380K.
None of these was catastrophic. This is what routine review finds before the year's largest claims are counted.
Network-allowed charges resolved. Documented Record for each claim.
Results from one client engagement. Outcomes vary by plan, claim mix, and documentation.
You're Probably Wondering
Doesn't our TPA already review claims?
They process and adjudicate them, and most check their own work. What no administrator can provide is a review from outside the claim, the network rate, and the administrative relationship. That's the layer we add, with your TPA, not around them.
Our TPA and network don't answer these questions. Why would they answer you?
Because the plan's right to that information is written into law and into the agreements we put in place. We make the requests and handle the pushback, in the plan's name. When a hospital objects, the finding already rests on its own contract, rates, and policies.
Will this slow payment or put us out of compliance?
No. A plan is entitled to the information it needs before it decides to pay, and the clock runs from there. Review finishes within 10 days of complete documentation, inside the plan's normal payment window.
Bringing in independent review is your call. We make it the easy one.
Keep your TPA, your network, and your broker. We work alongside your advisor and your stop-loss partner, fit however your plan is administered, and put the agreements in place that give the review standing. Your team's part is measured in approvals, not hours.
Advising a plan? See how advisors bring this to their clients.
For brokers
Start with one claim
Bring a large claim, a renewal you didn't like, or a question. We'll show you what independent review finds.