Manufacturing Employer’s Liability Reduced From $1 Million

Client

A manufacturing employer in the private sector with a national employee base of 340 and about 500 total lives on the benefit plan.

Challenge

The client decided to switch brokers during the fourth quarter, and chose Apex Benefits knowing it could help them deal with rising healthcare costs. However, Apex was put on a short timeline to help the client receive a competitive renewal with open enrollment season rapidly approaching. The client’s insurance provider would not release the detailed claims data and clinical case notes needed to help Apex negotiate the renewal. Therefore, competing stop loss carriers were comfortable with the risk profile only if able to “laser” one claimant at $1 million.

Using their clinical knowledge and expertise, the Kinetiq Health team secured a medical release form and connected directly with doctors at a hospital in New York to access case notes on the plan member’s prognosis. While the prognosis was a rare cancer claim, the information Apex received proved to underwriters the $1 million laser was a much larger amount than was necessary.

Solution

Using their clinical knowledge and expertise, the Kinetiq Health team secured a medical release form and connected directly with doctors at a hospital in New York to access case notes on the plan member’s prognosis. While the prognosis was a rare cancer claim, the information Apex received proved to underwriters the $1 million laser was a much larger amount than was necessary.

Results

Upon delivering the information to the competing stop loss carriers, Apex was able to negotiate a much lower laser liability of $400,000. That resulted in potential savings of $600,000 for the client.

 

Case Study

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