Health insurance for payers is rife with issues of all shapes and sizes. How to deal with them all, from high cost claims for Preemies, to out-of-network billed charges, skyrocketing specialty drug costs and others, while still grappling with the current year, planning for future years, fending off competitors, and pursuing opportunities - can become existential questions! Reinsurers can help because we provide the insights, steadying hand and safety net needed to tackle today's complicated healthcare challenges.
As many of you may have seen in one of my earlier posts, we, as reinsurers, are the Ambassadors of Quan. In many ways, we help clients walk the walk – whether they're launching a health plan, a new product or maybe just looking for ways to protect themselves better.
Our newest service, Swiss Re Remedy, is a suite of medical partners that covers our clients in all areas - from transplants, cancer treatments or Chronic Kidney Disease (CKD), imaging services, pharmacy benefit management, plan document and bill review, and even emerging technologies.
Here's one example where Swiss Re Remedy helped an international health insurance company have a member treated in the US:
1) The company informed us about a clinical situation causing consternation. A US medical provider had billed a significant amount for services. The client felt the costs to be incurred were very high and asked us to assist.
2) We reviewed the matter and identified someone among our suite of medical management partners who could help. A referral was made to the partner who could then work on a remedy.
3) Our bill review partner conducted a thorough review of the billed charges sent to the insurance company.
4) Along the way, our medical management team negotiated a 15% savings to the cost of the bill review. This was on top of any savings the partner identified or was able to achieve from the clinical care provider.
5) The review ultimately resulted in a 50% savings based off the original charges. Moreover, in this case, the clinical
procedures performed on the patient also often result in a follow-up procedure 8-12 months later. Accordingly, this second review also resulted in a savings of 32% on the second procedure.
This is just one of many examples where in being an Ambassador, we were able to provide
a great Remedy.
What kind of Remedies do you seek?