Due to the continuous routine case follow up, potential large claimants are tracked. Not only are claims savings significantly achieved, underwriting also benefits from the accurate risk assessment.
Summary: Despite being told by a TPA’s case manager that no BMT was planned on a patient with Leukemia, project BMT estimate after thorough research.
Intervention: an aggressive cost projection of $1,000,000 was estimated and relayed to the underwriter. Group renewed.
Result: The patient had a 4 month hospital stay, including a BMT. Total claim cost-$990,000.
Savings and benefit: No stop loss claim and $1 million of premium was captured with the renewal.