For most payers the days of relying only on PPO discounts for large claims are long over. Claim payers, as well as employers, require a reliable partner that can deliver results while satisfying the interests of each individual party. EthiCare Advisors has become known as that reliable partner that can coordinate the settlement of large claims, while keeping each party involved in the process.
EthiCare Advisors is used or recommended by: Insurance companies (health, workers compensation, and liability), managing general underwriters (MGUs) of stop-loss insurance; insurance intermediaries; insurance agents/brokers/consultants; third party administrators (TPAs); Taft-Hartley health and welfare funds; labor unions; other medical bill review/audit companies; governmental joint insurance funds; and self-funded employers. In the past three years alone, EthiCare Advisors has worked with more than 130 unique clients.
Our services are geared toward high-dollar medical claims and controlling costs for claimants with chronic conditions. We routinely handle: inpatient and outpatient hospital or clinic claims, physician claims, dialysis claims and air ambulance claims. There is no limit to the types of claims we will review.
For in-network claims, EthiCare Advisors realized additional savings on 63% of all in-network dialysis claims we reviewed in 2014-2015. We realized additional savings on 72% of all non-dialysis in-network claims submitted to us from 2014-2015.
For out-of-network claims, EthiCare Advisors realizes additional savings on 91% of all out-of-network dialysis claims we reviewed in 2014-2015. We realized additional savings on 83% of all non-dialysis out-of-network claims we received in 2014-2015.
We are known throughout the industry as a resource to claims payers for our ability to quickly and accurately assess a claim and provide settlement options. We specialize in handling high-dollar claims and claimants and discuss what outcomes the client wants, such as a signed release settlement, U&C, Medicare and AWP pricing data or a medical bill review. All settlement options are presented by EthiCare Advisors and discussed in detail with the claims payer.
The answer lies in the results that are delivered. Many “cost containment” vendors consider themselves in business with a phone line and a general understanding of the industry. Perhaps they can save some money on a claim and consider themselves successful, but success is measured in the eyes of the client. Since 2002 EthiCare Advisors has been a Medical Claims Settlement Specialist® which means we have specialists in most fields of our settlements.
Our dialysis settlement team is led by a former dialysis industry executive. Our hospital and physician claims settlement team is led by former executives from TPAs and MGUs. EthiCare’s knowledge base is backed up with years of experience and research that has led to the successful development of numerous proprietary databases. There is a difference in results when you partner with EthiCare Advisors as your Medical Claims Settlement Specialists®.
EthiCare Advisors is not a subsidiary of another cost containment company or PPO, competing stop-loss MGU or insurance carrier, nor are we owned by a provider. EthiCare Advisors, Inc. is a privately owned corporation. It’s owned by John T. Criscione, MBA and Mark S. Hartmann, Jr., MS who are both involved in the company. Both Mr. Criscione and Mr. Hartmann are industry veterans well experienced working at a third-party administrator (TPA) and stop-loss managing general underwriter (MGU) and TPA and health insurance brokerage, respectively.