Health Insurance Industry Issues and Legislation

A non-fee schedule state workers' compensation claim involving multiple cervical spine procedures in a non–fee schedule state exposed the payor to full billed charges totaling $159,000. With no mandated reductions in place, H.H.C. Group's attorney-led negotiating team intervened, applying clinical and billing expertise to secure a rapid, defensible resolution. The result was a significant reduction in liability and a signed provider agreement within one day.

Results:

Billed Amount: $159,000.00
H.H.C. Group Negotiated Payment: $36,000.00
Total Client Savings: $123,000.00
% Saved vs Billed Allowed: 77.4%

Non-fee schedule workers' compensation claims leave payors fully exposed when providers bill aggressively. H.H.C. Group delivers real protection through attorney-led negotiation and defensible payment strategies that PPO repricing alone can't achieve. Contact H.H.C. Group to review your non-fee schedule claims and uncover savings before full liability sets in.

H.H.C. Group announces the release of its newest white paper, Independent Reviews & Utilization Reviews: Payors' Ally in an AI-Driven Claims World. The paper examines how objective, board-certified medical reviews help payors reduce compliance risk, prevent costly appeals and protect plan assets amid the surge in AI-generated denials.

Backed by our attorney-led negotiating team and 30 years of trusted provider relationships, H.H.C. Group ensures every dollar paid is clinically necessary, contractually defensible and financially fair.

Download the white paper here or view the official press release here.

As Heart Month underscores the ongoing impact of cardiovascular disease, cardiac-related claims are becoming more frequent, more complex, and more expensive—driving significant financial and fiduciary risk for payors.

Cardiology claims often involve layered coding, multiple providers, implants, and billing practices that survive PPO discounts while still exceeding what's fair or defensible.

H.H.C. Group provides early, human-led review and attorney-driven negotiation to ensure cardiac claims are accurate, compliant, and paid appropriately before leverage is lost.

High-cost claims are accelerating due to increased utilization, specialty drugs, private-equity-backed providers, and growing clinical complexity—turning large claims into a fiduciary risk, not just a cost issue. In a recent webinar with The Granite List, H.H.C. Group shared real-world strategies for reviewing, negotiating, and resolving high-dollar claims with speed, accuracy, and defensibility—before overpayments are locked in. Find the full recap on our blog and learn how H.H.C. Group helps TPAs, stop-loss carriers, and plan sponsors protect their plans.

A single plan participant generated $9.1M in medical claims in one year, highlighting how quickly large-dollar exposure can escalate when claims aren't closely reviewed.

H.H.C. Group applies early, human-led oversight—combining attorney-led negotiation, coding and DRG validation, and independent clinical review—to uncover savings before payments are locked in.

Don't assume your largest claims are being reviewed closely enough—contact H.H.C. Group to review a claim or strengthen your high-cost claims strategy today.

U.S. healthcare spending rose 7.2% to $5.3 trillion in 2024, driven primarily by increased utilization and more complex medical services—not pricing, according to CMS.

As hospital stays, procedures, and claim intensity rise, payors face greater exposure from coding errors, inappropriate services, and unchallenged high-dollar claims.

H.H.C. Group provides the human-led review, clinical validation, and attorney-led negotiation needed to control utilization-driven risk before costs are locked in.