As a provider of medical stop-loss insurance, you may have heard about EthiCare Advisors’ claims settlement services. While many consider our claims settlement services second to none, we also want to remind you of other services we provide for stop-loss insurance carriers and managing general underwriters (MGUs) including:
Risk assessment underwriting reviews:
EthiCare’s proprietary knowledge base can serve as a second set of eyes during the underwriting process to help determine the projected cost of a particular risk for the upcoming benefit period. This service can be provided on one particular patient or as a review of the entire group. When a high-costs risk is identified, our claims settlement team can act upon your request to contract with a provider and provide certainty of ongoing cost, giving you an advantage over your competition.
Specific/Aggregate claim file audit:
Our claim file audit team is lead by a former claims manager of a third-party administrator (TPA). We can assist your team with any claims file overflow or for run-out of a particular program.
When you sell a new group, do you have a call with your underwriter, your claims manager, the third-party administrator (TPA) and broker to make sure the TPA knows about your expectations for cost containment as well as the resources you can provide them? If you’re not, you should consider it. If you are, EthiCare Advisors can make it better. Participated in literally hundreds of these calls, we can share our deep knowledge of the cost containment options. We have participated in literally hundreds of implementation calls and can share our deep knowledge of various cost containment options.
50% notice analysis:
These notices can provide a lot of advanced warning and how they are handled may make a difference in your loss ratio. Let EthiCare Advisors serve as your partner in culling the relevant information and taking action.
From “the TPA really messed up paying this claim and we need help” to “can you come and talk about dialysis at our next producers conference” and anything in between.
For more information, please contact Mark Hartmann at (888) 838-4422 extension 703.