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Manufacturing Employer’s Liability Reduced From $1 Million
A manufacturing employer in the private sector with a national employee base of 340 and about 500 total lives on the benefit plan.
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.
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.
More Case Studies
- January 20, 2022
MSD of Wayne Township was dedicated to employee health and wellness prior to engaging with Apex Benefits and its Kinetiq Health team in late 2019. While mostly satisfied with their wellness program, the school system was looking for opportunities to …
- December 16, 2021
The client made a switch in consultants to Apex just before the beginning of the fourth quarter and had already started the renewal negotiation process. The former consultant’s negotiated renewal rate suggested increased costs of $208,000.
- November 1, 2021
The savings found were substantial for the client. After discounts, rebates and fees the annual identified pharmacy savings were $110,156 for the client. Apex also discovered additional savings through clinical and specialty drugs of another $100,581. Those combined savings cut …