Health Insurance Industry Issues and Legislation
In-network doesn't always mean fair pricing. When a $296K cardiac claim still left a stop-loss client on the hook for an excessive liability, H.H.C. Group stepped in to negotiate deeper savings. With strategic case management and data-backed negotiation, we delivered results the PPO couldn't.
Highlights:
Billed Charges: $296,426PPO Allowed Amount: $252,555
Stop-Loss Responsibility Pre-Negotiation: $188,020
H.H.C. Negotiated Payment: $207,498
Total Savings: $45,056
Additional Savings Beyond PPO Rate: 18% below PPO
Overall Reduction from Charges: 30% saved
Even in-network claims have room for savings. Let H.H.C. Group uncover them.
Contact us to protect your plan and avoid costly overpayments.
Private equity ownership is reshaping healthcare — and not in favor of payors. With profit-driven billing practices, steeper charges, and reduced transparency, claims are getting larger and harder to contest. H.H.C. Group helps employers, TPAs, and stop-loss carriers push back with attorney-led negotiations, clinical reviews, and data-backed pricing that restore control in an increasingly aggressive billing environment.
Hospital consolidation is driving up costs for employer health plans — and H.H.C. Group helps payors push back. As dominant health systems gain leverage, prices are rising and contract restrictions are limiting employers' control. H.H.C. Group levels the playing field with attorney-led negotiations, deep clinical reviews, and data-backed pricing strategies that deliver up to 90% savings — even against the biggest providers.
CMS's proposed 2.4% rate hike for outpatient and ASC services signals rising reimbursement levels that will inevitably raise the cost of care for payors. While the rule also aims to boost transparency and move toward site-neutral payments, real-time claim costs are climbing. In this environment, H.H.C. Group's negotiation, review, and pricing services are more valuable than ever for protecting plan resources and pushing back against inflated charges.
UnitedHealth Group's Q2 earnings plunged 19% as it braces for $6.5 billion in excess medical spending—largely due to higher outpatient, physician, and Medicare Advantage costs. With other major insurers also reporting losses, it's clear the entire industry is grappling with rising claim pressure. H.H.C. Group helps clients push back with expert negotiation, clinical review, and fair pricing strategies that cut claim costs—even when the biggest payors can't.
