Health Insurance Industry Issues and Legislation

Even with PPO repricing in place, a 12-day in-network ICU stay for a 27-year-old male with severe sepsis still posed major financial exposure for the plan. Leveraging a long-standing relationship with the hospital's Patient Account Manager, H.H.C. Group's attorney negotiator secured a same-day agreement that cut costs dramatically.

The Results:

Billed Amount: $343,913
PPO Allowed Amount: $194,750
Negotiated Payment: $77,902
Incremental Client Savings: $116,848
% Saved vs PPO Allowed: 60.0%
Contact H.H.C. group today to ensure every claim is fair, defensible and backed by expert negotiation.

Real People. Real Savings.

Trusted relationships and clinical expertise deliver measurable results. Contact H.H.C. Group today to see how our negotiators turn high-dollar claims into real savings.

H.H.C. Group has earned ISO/IEC 27001:2022 certification for its Information Security Management System, confirming compliance with globally recognized standards for data protection and operational integrity. This achievement—complementing the company's ISO/IEC 9001:2015 certification—demonstrates H.H.C.'s unwavering commitment to security, quality, and client trust.

As President and CEO Bruce D. Roffé noted, "Behind every claim, every review and every negotiation, there are real people—our team and our clients—who trust that their data and their business are protected. ISO/IEC 27001:2022 validates that trust."

Catastrophic claims are rising fast — self-insured health plans are now 4.3 times more likely to face a $1 million–plus claim than just a decade ago. With medical inflation, high-cost specialty drugs, and aggressive billing practices driving the surge, TPAs and stop-loss carriers need smarter strategies to control risk.

H.H.C. Group delivers the expertise, speed, and leverage to protect margins — with attorney-led negotiators, clinical and financial reviews, and proven savings of up to 75% on high-dollar claims.

A new Patient Rights Advocate report reveals price variations of up to 27 times for the same appendectomy within a single state — with some hospitals charging $650 and others over $26,000. Despite federal transparency rules, only 15.5% of hospitals disclose real dollar amounts, leaving employers and TPAs exposed to bloated claims and compliance risk.

H.H.C. Group bridges the gap between transparency and true accountability — combining attorney-led negotiators, certified coders, and clinical reviewers to ensure every payment is fair, defensible, and financially justified.

Contact H.H.C. Group today to make biosimilars a core part of your cost-containment strategy and start capturing the savings your plan deserves.

A new AHIP and BCBSA report found that nearly 40% of claims submitted to the federal Independent Dispute Resolution (IDR) process in 2024 were ineligible, yet many still advanced to arbitration — resulting in billions in unnecessary payments and rising premiums. The analysis estimates $5 billion in wasteful spending since the No Surprises Act took effect, largely driven by private-equity-backed providers abusing the system.

H.H.C. Group helps payors avoid this costly trap by resolving disputes early through attorney-led negotiation, defensible pricing, and fair settlements — protecting plan assets before claims reach the broken IDR process.

New data from EBRI shows stop-loss adoption surged to 74% of employers, reflecting growing concern over catastrophic claims. But as claim severity and frequency rise, brokers and payors can't rely on stop-loss coverage alone — they need proactive claim control.

H.H.C. Group helps close that gap through attorney-led negotiations, independent reviews, and reference-based pricing strategies that reduce liability before a claim ever reaches stop-loss thresholds.