Health Insurance Industry Issues and Legislation

Even with PPO discounts in place, this ENT surgery claim showed that "discounted" doesn't always mean fair. H.H.C. Group's attorney-led negotiator reviewed the $60,620 in-network bill, identified excessive charges, and secured a signed agreement for just $14,000 — a 74% savings beyond the PPO allowance. This case proves how expert negotiation and clinical insight protect plan dollars and deliver real, measurable results.

The Results:

Billed Amount: $60,620
PPO Allowed Amount: $53,951
H.H.C. Negotiated Payment: $14,000
Incremental Client Savings: $39,951
% Saved vs PPO Allowed: 74.1%

Contact H.H.C. group today to ensure every claim is fair, defensible and backed by expert negotiation.

H.H.C. Group will participate in the Self-Insurance Institute of America's (SIIA) 2025 National Conference & Expo, October 12–14 in Phoenix, AZ — the largest event dedicated to the self-insurance and captive insurance marketplace.

On Monday, October 13, from 3:15 PM – 4:30 PM MDT, H.H.C. Group President and CEO Bruce D. Roffé will join the panel "New and Innovative Solutions to High-Cost Medical Claims," exploring how plan sponsors can identify the conditions that trigger multi-million-dollar claims and apply innovative strategies to control costs across medical, dental, auto and workers' compensation sectors.

H.H.C. Group proudly announces the launch of its new "Proof in the Pudding" savings program — a no-risk opportunity designed to show third-party administrators (TPAs), stop-loss carriers and self-insured payors the real impact of expert claim negotiation and cost containment solutions.

Prospective clients are invited to submit up to six high-dollar in-and out-of-network claims for analysis and negotiation and H.H.C. will return results with no cost and no obligation — and savings that routinely outperform industry benchmarks. *Offer is for new/prospective clients only.

Biosimilars are safe, clinically equivalent alternatives to costly biologics, but PBM restrictions often block access and drive up costs. H.H.C. Group helps plan sponsors, TPAs and stop-loss carriers cut through those barriers so biosimilar savings reach the plans and members they're meant for.

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.

Many self-insured employers could face stop-loss premium hikes of 11–20% in 2026, driven by rising catastrophic claims, costly cancer treatments, and new high-priced gene therapies. With stop-loss carriers bracing for heavier claim exposure, employers need proven strategies to control large-dollar claims.

H.H.C. Group helps reduce that risk through attorney-led negotiations, clinical and financial reviews, and repricing solutions that slash catastrophic claims by up to 90%.

Despite federal requirements, hospitals are posting fewer prices for services, leaving employers and insurers with little visibility into true costs. With weak enforcement and aggressive revenue cycle tactics, payors face growing risk of overpayment on large-dollar claims.

When hospitals hide prices, payors lose leverage — H.H.C. Group helps you take it back.