TMHCC Achieves Cost Saving Success through Operational Excellence

As the cost of catastrophic claims continues to rise, Tokio Marine HCC – Stop Loss Group (TMHCC) continues to find innovative ways to assist you and your clients with the claims process. Due to the pandemic and the rise of healthcare costs in general, TMHCC is constantly discovering new ways to help your clients navigate the claims process while saving them money. One way we have achieved this mission is by expanding our exemplary staff, enabling them to promptly respond to status requests and assist in navigating complex claims.

The following is an example of how our dedicated staff helped a client manage their high dollar claims to achieve a savings
of 77%.

A third-party administrator (TPA) notified TMHCC’s Customer Client Representative (CCR) about an unknown claimant who had accumulated over $11 million in billed claims. The claimant was unknown because everything had been billed through Medicaid.

The CCR arranged a meeting with the broker, TPA, and underwriter to discuss the details of the case and discovered that everything had been treated as “out of network.” TMHCC’s staff helped the client gather all required eligibility documents and assisted them with the disclosure review. Once the requirements had been met, TMHCC’s Preliminary Claims Unit (PCU) worked with the vendor to negotiate the claims down to $2.5 million, a total savings of 77%.

TMHCC’s talented staff of CCRs, nurses, and underwriters go above and beyond to help your client save time and money. By listening to the demands of the market, TMHCC has developed exceptional products, unparalleled resources, and value-added services that set us apart in the industry. Please visit our website to learn more about our innovative products and services or contact your regional marketing representative.