Health Insurance Industry Issues and Legislation
The Results:
Billed Charges: $120,027PPO Allowed Amount: $88,268
H.H.C. Negotiated Payment: $30,000
Incremental Client Savings: $58,268
% Saved vs PPO Allowed: 66.0%
Turnaround Time: 5 business days
Contact H.H.C. group today to see how early trigger code intervention can turn hidden risks into real savings.
Ambulatory Surgery Centers are surging nationwide, promising efficiency but driving hidden risks for payors — from aggressive coding to opaque pricing and fewer negotiation options. What was once seen as a cost-saving alternative is now a hotspot for inflated claims.
H.H.C. Group delivers the attorney-led negotiations, clinical reviews, and benchmark-based pricing strategies needed to contain ASC costs and protect your plan.
With more than 14 years at H.H.C. Group, Dr. Roger Hinkson ensures every review is clear, evidence-based, and defensible. His leadership in utilization and independent reviews strengthens quality control, safeguards plan assets and reinforces fairness in patient care.
H.H.C. Group's commitment to detailed oversight delivers the confidence payors need in today's complex claims environment.
Dr. Brian Cruz, Medical Director of H.H.C. Group's New York IDR program, ensures every dispute is reviewed fairly, impartially, and with full clinical rigor. His leadership brings structure, evidence-based standards, and transparency to surprise billing disputes — helping both payors and providers achieve fair outcomes while protecting plan integrity.
With Dr. Cruz's leadership, H.H.C. Group ensures IDR outcomes are consistent, defensible, and fast — providing payors with fair resolutions and reducing costly conflict with providers.
Employer health plan costs are projected to rise 10% in 2026, with catastrophic claims and high-cost drugs like GLP-1s and cancer therapies driving the increase. These pressures put self-insured employers, TPAs, and stop-loss carriers at risk of runaway expenses. H.H.C. Group delivers the cost-containment strategies needed to fight back — attorney-led negotiations, PPO partner discounts, bill audits, and reference-based pricing that deliver savings of up to 90%.
A new study found that the No Surprises Act's independent dispute resolution (IDR) system has already driven $5 billion in added costs, with cases skyrocketing far beyond federal projections. For payors, delays, inflated awards, and provider-driven disputes are creating serious financial exposure. H.H.C. Group helps plans navigate this high-volume environment with attorney-led negotiation and evidence-based determinations that cut through the noise to achieve reasonable settlements with providers, enabling payors to avoid the time-consuming, frustrating and potentially costly IRE process.
