The medical stop loss captive is uniquely positioned between the primary payer and stop loss carrier.  A central challenge for the medical stop loss captive and its owner, will be the reality of high dollar hospital bills exceeding the primary payer level and not reaching the stop loss threshold. The days of simply passing the highest dollar claims off to the MGU or stop loss layer without due diligence at lower payment levels is rapidly diminishing.

Good claims oversight by the captive and/or its owner mitigates stop loss premium increases while helping to ensure the captive's own financial success, including its viability as an actual claims paying entity.

It is important to deal with a hospital/facility bill review entity that does not charge on “percentage of savings” or contingency basis. Our Foundation for Negotiation™ approach to high dollar claims is the cornerstone of our success in facility and hospital claims review.