HELP… it’s becoming less of a request. More often than not, we see our producers feeling that they must undertake situations alone without collaboration. At USBenefits, our partnerships are important to us. We invite your requests and we’ll do our best to jump through hoops to assist you with your challenges.
We understand the demanding pressures on brokers and TPAs to perform to their client’s expectations and USBenefits is committed to our partners’ cost containment efforts. The USBenefits’ claim team has on average, over 35 years’ experience handling medical claims – from working at BUCAs, TPAs and the large national stop-loss carriers – so we can likely relate to your dilemma.
We understand the pressures on TPAs to pay claims quickly and accurately, while responding to broker, provider, and member inquiries. Not to mention the performance guarantees that can tie a substantial amount of money to the TPA’s level of service.
That’s why USBenefits wants to help take some of that pressure off the TPA when it comes to cost containment and offer alternatives to achieve the best possible outcomes. With our collective (TPA and USBenefits) experience, our cost containment vendors often are able to exercise their relationships and experience to the TPA’s and group’s benefit. Our vendors conduct an in-depth analysis of provider bills and medical notes and provide a detailed report that references the medical journals they reviewed to arrive at their opinions.
We know that talk is cheap and actions speak louder than words. So how can we help our partners? Below are two recent examples where our vendors were able to provide cost savings to the Plans.
Cost Reduction During Challenging Times
The first situation was a claimant that was going through intense chemotherapy. When the in-network claim came to USBenefits, it hit our radar with PPO charges of over $1.3 million dollars. Needless to say, we thought it was necessary to have a vendor review the charges and see if they could negotiate a better price for the Plan. The vendor used the hospital cost data to determine the provider was charging 10 times their cost for the treatment. After weeks of negotiation, the vendor was able to successfully negotiate a contract with the provider. To date, this has saved the Plan over $680,000 – below the PPO rate. Further, the contract continues through the end of 2025.
Managing High-Cost Claimants
In the second example, one of our TPA partners notified us of a claimant that had just been approved for a very high-cost drug. The TPA anticipated that this claimant would be subject to a laser deductible in the upcoming plan year due to the projected costs, which were quoted by the local hospital at $176,000 per month for 12 months – totaling over $2M annually. The TPA asked if we could recommend a vendor to help reduce these costs.
We immediately contacted one of our trusted vendors who conducted an extensive research and negotiation process. After several weeks, the vendor was able to find an infusion center near the claimant’s home that could provide the drug for only $68,750 per month – a savings of $107,250 per month. By significantly lowering the cost, we were able to help the TPA manage the laser and save the Plan over $1.2M!
While these are just two examples of the savings USBenefits has provided our Plans, our partners know our mantra of how our goal is their goal. We have literally saved our partners millions of dollars over the last few years. In fact, on average, USBenefits saves 20 percent of a Plan’s premium with our cost containment efforts.
As the adage goes – two heads are better than one. We welcome the opportunity to participate in solving your challenges.
