Stop-Loss Claims Are Surging — Don't Face Them Without Support from H.H.C. Group

October 01, 2025 Out-of-control claims are becoming the new standard and they're accelerating fast. In 2024, self-insured health plans were 4.3 times more likely to face a $1 million–plus claim than just a decade ago. According to the latest data from Tokio Marine HCC, these jumbo claims are hitting harder, faster and more often and the pressure shows no sign of letting up.

That's a growing problem for third-party administrators (TPAs) and stop-loss carriers already grappling with rising severity, increasing resistance from providers and inflation-driven billing practices.

Jumbo Claims Are the New Normal

A single $1 million–plus claim can throw off underwriting projections, inflate loss ratios and jeopardize client retention. Today, it's not just one claim, the risk is multiplying fast.

Claims exceeding $2 million are now 13.5 times more common than they were in 2013. Cancer alone accounts for 35.1% of total stop-loss costs, and that share is still climbing. Even with a slight dip in average severity, high-dollar claims are still coming in at nearly $1.76 million each.

What's driving this surge? A combination of factors: high cost specialty drugs and gene therapies, the elimination of lifetime coverage caps, medical inflation, aggressive billing practices and fewer limits on what providers can charge. Together, these trends are creating a high-risk landscape where more employers are exposed to catastrophic claims, often without realizing just how vulnerable they are.

The Market Is Tightening — Your Defense Needs to Be Smarter

Across the industry, the pressure is building. Stop-loss premiums are climbing, underwriting standards are becoming stricter and there's far less tolerance for unmanaged risk. Carriers and TPAs alike are being forced to scrutinize claims more closely and act faster to protect margins.

According to the 2025 Accident & Health Market Report, nearly all carriers reported tightening underwriting criteria and applying more rigorous review processes in response to growing large-claim volatility and medical inflation.

HHC Group equips payors with the speed, accuracy and leverage needed to push back and succeed in a market that leaves little room for error.

Proof in the Pudding: Backed by Real Numbers

H.H.C. Group doesn't just talk about savings, it proves them. Our "Proof in the Pudding" program gives prospective clients a no-risk opportunity to see real results. Simply send us up to actual high-dollar in and/or out-of-network claims, and we'll negotiate them upfront at no charge— so you can compare our performance before making any commitment.

The results speak for themselves, two out of every three out-of-network claims are successfully reduced, with savings as high as 75% or greater. In-network claims, while involving higher dollar amounts, $100,000 or more, still deliver quantifiable savings.

Speed is never sacrificed. Most claims are reviewed and resolved within 5 to 7 business days, not weeks. No fluff. No guesswork. Just solid, data-driven results that demonstrate H.H.C. Group's value from the start.

H.H.C. Group: Built for This Environment

When the claim size climbs, you need a partner who doesn't blink. H.H.C Group handles the toughest, highest-dollar claims and wins.

What Sets Us Apart:

• Attorney-Led Claim Negotiation: Slash large-dollar claims by up to 75% or more, even with PE-backed providers.
• Access to Major Preferred Provider Networks: Leverage existing agreements to maximize savings on claims down to $1.
• Independent Clinical and Financial Reviews: Confirm necessity, validate coding and expose unjustified charges.
• Reference-Based Pricing: Anchor payments to fair, transparent benchmarks — not inflated fee structures.
• Fast Turnaround: Most claims resolved in 5–7 business days to keep you ahead of aggressive billing tactics.
• 30 Years of Proven Results: With a proven 30-year track record of successfully negotiating both in- and out-of-network facility claims, H.H.C. Group remains a trusted partner for cost containment nationwide.

Stop Paying What You Don't Owe

The days of passive claims review are over. The market is shifting fast — toward higher exposure, tighter margins and more aggressive billing behavior.

If you're ready to see what real negotiation power looks like, let us review 15–20 claims and show you what we can do. Let's make the numbers work for you — not against you.

Contact HHC Group today to get started.

Real People. Real Savings. Real Strategy.