Health Insurance Industry Issues and Legislation

Even after a 37% in-network PPO discount, a $118K orthopedic surgery claim still raised red flags. H.H.C. Group stepped in and secured an additional $38K in savings—32.7% below the PPO allowed amount—within just five business days.

Key Results:

Billed Amount: $188,539.58
PPO Allowed: $118,539.97
Final Payment: $80,000
Additional Savings: $38,539.97 (32.7% below PPO)
Turnaround: 5 business days

Real People. Real Savings.

Ready to maximize claim value—even in-network? Contact us today.

Higher hospital margins aren't lowering costs—they're fueling aggressive billing.

As large systems inflate charges, H.H.C. Group helps payors stay ahead with attorney-led negotiations, clinical reviews, and Medicare-based repricing.

In The Self-Insurer, CEO Bruce Roffé highlights how H.H.C. Group uses ODG guidelines and URAC-accredited processes to deliver fair, evidence-based medical reviews.

GLP-1 medications like Ozempic and Wegovy now account for 17% of pharmacy claims—up from just 6% in 2022, per CBIZ.

As drug costs surge, H.H.C. Group helps payors ensure treatments are appropriate and costs are justified through expert reviews and bill analysis.

ERISA Industry Committee (ERIC) warns that dominant hospital systems are stifling competition and inflating prices—not cost-shifting.

H.H.C. Group helps payors fight back with tough negotiations, expert repricing and exceptional bill reviews.

New Lockton data shows most HR leaders now prioritize cost over talent retention—but few use proven tools like reference-based pricing.

H.H.C. Group helps payors act now to control spend.

A new report finds SMBs are prioritizing cost control over talent retention.

H.H.C. Group helps SMBs reduce healthcare spend—so they can reinvest in what matters most: retaining top talent. Our scalable solutions improve plan oversight and deliver real savings.