Artificial Intelligence (AI)…  The phrase and concept that transitioned from predictive modelling (inclusive of loss rating / experience models) of yesteryear to The Terminatorof tomorrow. While the debate continues as to the value, predictability and credibility of...

The following article was featured in the Summer 2022 issue of BC Advantage magazine but still has tremendous relevance today. We feel it is very worthy of a second look and warrants redistribution as the market is experiencing a breach in aggregate coverage, which...

In healthcare, a doctor’s priority is to provide the best care for a patient. However, this can sometimes mean deviating from our industry’s processes and regulations. One such process is pre-certification, also known as prior authorization, which may be required by...

USBenefits does not accept rebates or incentives from the vendors – whether through claim review, subrogation recovery, or a negotiation. We work hard to save our mutual clients as much money as we can on every claim because “Your goal is our goal – to provide the...

USBenefits can assist you and fully insured clients to consider if stop loss is appropriate for their needs. To help us properly and expeditiously review your RFP, all fully insured submissions are subject to the following in addition to our underwriting guidelines....

By Mike Lanza In our industry, there is much hesitancy to review in-network claims for billing errors and unnecessary treatment. One concern is that an audit will take too much time and may violate prompt pay rules, but that concern should not prevent a detailed audit...

What’s the most important aspect of shopping for stop-loss insurance? The first response is usually the lowest price, and maybe a distant second is name recognition. However, you rarely hear claim handling even being mentioned. So why is that? Probably because no one...

With inflation at 40-year highs for almost a year now, and the Federal Reserve raising interest rates to combat inflation, there are predictions of a recession in 2023/2024. What can a Self-Insured Plan do to keep medical costs down to retain employees during the...

In a recent discussion with employers, most knew they had Stop-Loss coverage for their self-funded medical plan. They further understood that it’s protection from a large loss. However, there was some confusion as to the role and relationship between the Claims...