Health Insurance Industry Issues and Legislation

Even after a 45% PPO discount, a high-cost in-network spine surgery still left the plan exposed to excessive liability just days before year-end. Through expert clinical review and attorney-led negotiation, H.H.C. Group secured a fair, defensible agreement in two days—cutting the PPO-allowed amount nearly in half and delivering more than $137,000 in additional savings.

Results:

Billed Amount: $637,245
PPO Allowed Amount: $287,392
HHC Negotiated Payment: $150,000
Total Group Savings: $137,392
Percent Saved vs PPO Allowed: 47.8%

Start the year with stronger claim controls.

Contact H.H.C. Group to evaluate high-cost claims, uncover savings beyond PPO discounts and ensure every payment is fair, compliant and defensible.

At H.H.C. Group, every claim negotiation is handled by real people with the expertise to drive deeper savings on high-dollar claims. Our attorney-led negotiators—who are also licensed health insurance adjusters—work alongside certified coders and licensed pharmacists to identify overbilling, challenge inflated charges and push beyond standard discounts to deliver maximum financial impact.

Don't leave savings to automation.

Contact H.H.C. Group to put proven human expertise behind your toughest claims and unlock greater savings today.

High-cost claims continue to surge, putting brokers, TPAs and payors under increasing financial and fiduciary pressure. In this on-demand webinar replay, H.H.C. Group's experts break down why catastrophic claims are rising, where hidden costs occur and how attorney-led, human-driven negotiation delivers defensible savings beyond automation alone.

Watch the recording to learn practical strategies you can apply now to protect plans and control high-dollar claims.

A must-listen for brokers, TPAs and employers navigating today's high-cost landscape.

A new Medscape analysis highlights how hospital consolidation and healthcare lobbying continue to push prices higher, often blocking meaningful cost-containment reforms at the state and federal levels.

As market forces drive charges up, payors can't rely on policy fixes alone — they need defensible, claim-level strategies today.

H.H.C. Group helps payors respond where it matters most: through expert negotiation, clinical review and fair payment determinations that protect plans from inflated costs.

New polling from KFF shows that health care affordability remains a top financial concern across the U.S., with nearly half of adults struggling to afford care and more than one-third delaying needed treatment due to cost. These pressures often surface later as higher-acuity, higher-cost claims — increasing risk and scrutiny for brokers, TPAs, stop-loss carriers and payors alike. As affordability challenges persist, verifying billing accuracy and negotiating fair payments becomes critical to protecting plan assets.

Don't let downstream cost pressures turn into avoidable claim exposure. Contact H.H.C. Group to ensure every high-cost claim is reviewed, negotiated and paid fairly, accurately and defensibly.