By Curtis Beharry, Vice President of Client Services, EvergreenRe

Health plan clients often access our expert advocates who are dedicated to identifying opportunities to transfer risk to Social Security disability, workmen’s compensation, liability carriers and to members themselves.

Helping chronically disabled members who qualify for government assisted programs or other carriers can benefit the health plan member, but can also provide tremendous savings for health plans.

For instance, just recently by shifting a member with severe combined immunodeficiency to SSI, the health plan will save in excess of $146,170. The health plan had made payments of $62,624, and was looking at estimated costs for the upcoming year of approximately $83,000 with possible complications of bone marrow rejection and infection.

Another health plan with a member diagnosed with a brain tumor, subdural hematoma, osteomyelitis and seizures had already made payments of more than $390,000 for care. With possible complications such as re-lapse of the tumor or hemorrhage potentially generating claims in excess of $237,000, shifting the member to SSI could save the health plan more than $100.000.

To maximize success in transferring risk, it is critical to quickly assemble all necessary documentation and medical evidence from employers, financial institutions, physicians, and other providers to shift members out of a health plan and into the appropriate program.

In a well structured program, clients pay for these services only after their eligibility has been facilitated and an organization realizes financial benefit and risk mitigation. This contingency structure provides plan members a free service to help them navigate the arduous application process, and ensures that clients pay for services that guarantee a return on investment.

For additional information call Curtis Beharry at 888-811-7280 or email reinsure@evergreenre.com.