BETTER STOP LOSS INSURANCE

WE’VE STOPPED WRITE-OFFS FROM STOP-LOSS

Health coverage has become one of the most fundamental benefits offered by today’s employers. But some employers may face significant costs associated with frequent and/or expensive claims.

Stop-loss health insurance can provide a path toward reimbursement, allowing employers to continue caring for their workers without putting a dent in the company budget.

Here’s how Titan Health can help. We’ve already assisted numerous hospitals and healthcare systems with revenue cycle management and reimbursement. Our experienced team can likewise help with reimbursements associated with medical stop-loss insurance.

What Is Stop-Loss Health Insurance?

A stop-loss medical policy is designed for employers who self-fund their employee healthcare plans. It allows employers to provide benefits while mitigating the risk of assuming 100% liability for frequent and/or catastrophic insurance claims.

With a stop-loss policy, the insurer — not the employer — is responsible for any losses that exceed a specific deductible limit

This setup makes stop-loss health insurance an effective, affordable plan for small to midsize businesses. In many cases, small business owners can have a deductible limit as low as $10,000, which means that the insurer will pick up the tab on any claims that exceed this limit.

That’s good news for business owners. Employers with stop-loss insurance can continue to provide invaluable medical coverage to their team members without depleting their cash reserves or increasing their overhead.

There are two broad types of medical stop-loss insurance: specific and aggregate. Here’s an overview of each.

Specific Stop-Loss Insurance

Specific stop-loss insurance (sometimes called “individual stop-loss”) provides risk coverage for claims made by an individual.

For example, if an employer has a staff member with an unusually large number of claims — or who requires catastrophic assistance — specific stop-loss coverage will protect the employer from the costs associated with such claims from a single employee.

This type of stop-loss policy protects against expenses related to individual employees who experience a catastrophic medical emergency. But this policy can also provide coverage for an employee with a chronic medical condition as it protects the employer from atypical insurance costs.

Aggregate Stop-Loss Insurance

While specific stop-loss coverage focuses on individual team members, aggregate stop-loss insurance covers the claims of all covered members. In an aggregate stop-loss policy, the insurer will reimburse the company only when the total claims rise above the employer’s deductible.

The exact deductible limit is determined via contract and typically resets each year, just like an individual insurance policy. This type of stop-loss policy is good for covering larger teams, especially the younger staff who have less risk of needing atypical or chronic medical coverage.

However, employers may want to consider using both specific and aggregate stop-loss insurance to protect their employees and their budget.

Stop-loss insurance is designed for self-funded health plans. Ordinarily, employers who fund their own health plans become solely responsible for their employees’ medical costs.

Purchasing stop-loss health insurance provides coverage once healthcare costs reach an agreed-upon deductible limit. Once this limit is reached, the insurance provider will reimburse the employer for the additional expenses.

For example, if Company X purchases stop-loss insurance with a $15,000 deductible, the company will be responsible for all of its employees’ medical expenses as long as they remain under $15,000.

But once they reach that limit, the company’s insurance provider will reimburse any additional medical expenses for the remainder of the year.

This arrangement prevents employers from experiencing the burden of frequent or catastrophic medical expenses. It also allows employers to continue providing their employees with top-quality medical care without dramatically increasing overhead.

Self-funded insurance coverage can take a heavy toll on small to midsize employers. Many companies seek to mitigate costs by sharing the expense of self-funded healthcare plans.

A “group medical captive” plan allows multiple companies to work jointly to fund healthcare options for their employees. Group captive insurance can be a great option for small business owners to provide a competitive benefits package even before they have the working capital to do so on their own.

A stop-loss insurance policy does not replace group captive insurance. Instead, it has the potential to augment this business strategy. Pairing medical stop-loss insurance with a group captive plan can ensure that business owners obtain lower prices in the purchasing of a plan as well as for the cost of medical disbursements.

A stop-loss insurance policy generally offers identical coverage to the original insurance policy. Stop-loss insurance is simply an extension of the original policy and will cover all of the same expenses that the healthcare plan is designed to provide.

If a healthcare plan provides coverage for routine surgery, stop-loss insurance can help pay for these expenses in the event that they exceed the employer’s deductible limit.

In other words, stop-loss insurance doesn’t alter the terms of the insurance policy itself. Instead, a stop-loss health plan is designed to reimburse employers once medical expenses exceed the employer’s contractual deductible limit.

Stop-loss insurance coverage offers benefits for employers and employees alike. Here are just a few of the benefits of medical stop-loss insurance.

Reduces the Cost of Self-Funded Insurance Policies

Stop-loss policies are ideal for employers who self-fund their health benefits. Typically, this way of operating forces employers to take on considerable risk when it comes to frequent and/or large claims.

But stop-loss coverage comes with a limit that the employer must contribute to these medical disbursements. Once the employer reaches that limit, the insurer will reimburse the employer for the additional expenses.

Small to midsize businesses can therefore rely on a stop-loss policy to mitigate the cost of medical care. This can be a useful strategy for businesses that need to offer their workers health benefits but don’t have the capital to scale their operations to that level.

As a result, stop-loss coverage keeps costs low and allows businesses to keep their funds focused on their core products and services.

Enables Small Businesses to Provide First-Rate Coverage

Small businesses face a challenge when it comes to attracting and retaining top talent. Many business owners have been forced to evolve their benefits package to compete with other employers.

By reducing the overall cost of medical care, a stop-loss policy may incentivize business owners to purchase a more attractive medical plan than they couldn’t afford otherwise.

Stop-loss medical coverage gives even small startups the ability to offer first-rate medical coverage so they can grow their team thanks to competitive benefits.

Creates Different Layers of Protection

Because stop-loss insurance can either be aggregate or specific, employers can adapt their healthcare coverage to offer multiple layers of protection.

For example, an employer may choose to implement an aggregate stop-loss medical policy that covers the entire team while also using a specific stop-loss policy to protect individual team members.

Some employers may even choose to use a technique known as “lasering.” As the name implies, this method lets employers apply stop-loss coverage to individual employees who require frequent or costly medical care — delivering coverage with a laser-like focus.

Allows Employers to Customize Healthcare Options

Many employers choose to self-fund their insurance in order to retain control over what services they cover — and for how much. A self-funded plan gives employers the power to tailor their specific coverage to their team members or to design a benefits package that helps attract and retain staff members.

But without stop-loss coverage, this can be expensive. Stop-loss coverage keeps the overall cost of insurance as low as possible, which provides employers with the financial headroom to make strategic decisions about how best to design their healthcare policy.

It also means that employers can offer a plan that reflects their company and not merely implement another policy created by an insurance company.

Protects Employees with Chronic or Catastrophic Medical Needs

Job seekers with chronic conditions can face an uphill battle when it comes to finding employment. No employer can legally discriminate against an employee with medical conditions, of course, but a stop-loss plan can provide coverage for unusually frequent and/or catastrophic medical costs.

Employers who fund their own medical coverage can use stop-loss coverage to meet the needs of all of their workers without fear of how major medical expenses might impact their business.

Ultimately, stop-loss insurance provides a means by which companies can be more inclusive, offering coverage to employees with unique medical needs or conditions that have a higher probability of frequent care.

Maintains a Short Revenue Cycle

Ideally, stop-loss reimbursements happen quickly and efficiently. This ensures that a business owner maintains a steady cash flow and is not financially hindered by paying for medical coverage only to wait for the insurance provider to submit reimbursement.

For some employers, this influx of reimbursement money can create some breathing room or be used to supplement plans for business expansion.

In other cases, a rapid reimbursement plan can be helpful in covering operating costs and keeping the cost of business ownership to a minimum. And with flexible deductible limits, companies can count on a reimbursement plan that reflects the needs of their business.

Small business owners consistently list medical expenses among their chief financial challenges. Stop-loss insurance can offer much-needed relief, but only if these same companies receive the medical reimbursements to which they’re entitled.

The amount of unclaimed medical debt is estimated to be in the millions of dollars each year. Granted, every business is different, but these unclaimed reimbursements could be taking a bite out of the employer’s bottom line just as easily as the cost of medical coverage.

In an age where small businesses all too commonly fail, it’s important to take control of every penny. Ignoring unclaimed medical reimbursements can limit a company’s bottom line and deprive the company of the working capital needed to expand and flourish.

At Titan Health, we specialize in helping medical facilities pursue reimbursement and secure the claims money to which they’re entitled. Through our customized approach, we work to understand and assess your needs, designing a unique plan that fits you.

In the past, our Zero Balance audit and recovery services have helped hospitals across the country recover more than $325 million in unclaimed revenue.

If your system relies on some form of stop-loss coverage, Titan Health can assist you in ensuring that you receive full reimbursement for all of your medical claims. We have experience working with single-facility providers as well as clients who operate out of multiple medical facilities.

No matter your needs, we can provide services to make sure that you receive the reimbursements you need to tap into additional working capital and continue providing a superior standard of patient care.

Our experienced advisory team can also help you evaluate your stop-loss coverage. We can highlight strategies to help you customize your plan for your current workforce as well as devise ways to keep your benefits package both affordable and competitive.

When you partner with Titan Health, you’ll receive our Zero Balance Audit and Recovery service as part of your overall package.

Titan Health recently partnered with a midwest health system to rapidly diagnose and resolve an underpayment problem. After identifying errors in billing code systems and billing processes, Titan Health successfully recovered $2.9 million in previously lost revenue spanning 970 patient accounts.

Imagine what your healthcare system could do by tapping into unclaimed revenue. Whether the issue stems from stop-loss reimbursements, problems with billing, or other common challenges, Titan Health can ensure that your business gains access to working capital, helping you optimize your cash flow and keep your patients first.

SCHEDULE A FREE CONSULTATION

SEE WHAT BETTER RCM CAN LOOK LIKE FOR YOUR ORGANIZATION

WE DELIVER RESULTS THAT MATTER

Secondary Review, Primary Results

$3 MILLION

Identified in missed
revenue as a secondary
vendor for a large
Southwest Hospital,
reviewing 920 accounts
in just 7 months.

Partnership That Delivers

$36 MILLION

Recovered over 10 years
for a Southwest health
system, including $8M in
2023 alone.

Focused Commercial Claims

$17 MILLION

Recovered from
commercial claims
only, averaging $1-2M
annually for a large
Midwest medical center.

Specialized Solutions

$750,000

Recovered in one year
for a Midwest hospital,
focusing solely on
coordination of benefits
claims.