Industry Insights

You can probably imagine that working with more than 100 third party administrators (TPAs) means that HM Insurance Group (HM) receives tens of thousands of claim detail files every year. It’s a lot of data to manage. Files come into a secure, designated Stop Loss claims email box or via an FTP site. They are then saved to a corporate drive so our Claims team can format the TPAs’ Excel files into a format acceptable for loading into our claims system. The entire process takes a lot of manual work.  

I have a confession to make. As I watched the Coronavirus pandemic spread throughout the world and into the United States in late January and February, I was openly derisive about the potential impacts. I was convinced this would just be another flu (don’t we have one of those already), and this would not likely be a significant concern, both from a risk/loss perspective and from a societal impact standpoint. It’s a good thing I learned an important lesson a long time ago: be humble in defeat. 

Health care claims are more expensive than ever (many exceeding $1 million). In this industry, we frequently see the impact catastrophic claims could have, and it’s our job to help protect our clients’ financial stability should they face them. To make matters worse, some statistics I have heard in training seminars show that up to 10 cents of every dollar spent on health care goes toward paying for fraudulent health care claims.

We’ve all heard about gout. It’s that sharp, hot pain and swelling that most commonly afflicts the big toe. One of the world’s oldest recognized diseases, gout was first identified by the Egyptians in 2640 BC and has been viewed as a lifestyle disease of the rich and affluent, primarily because of its connection to certain more expensive dietary habits. This “disease of kings” has been problematic for ages, with little change in the treatment options that first were identified thousands of years back – until a few years ago.

The news is full of stories about health-related vaping incidents. At this point, medical professionals haven’t even determined all the ways in which e-cigarettes can injure the human body – and vaping was initially promoted (somewhat innocently) as “an alternative to cigarettes.” But there have been issues ranging from breathing challenges to lengthy hospital stays for life-threatening lung conditions to a shocking number of deaths now being tied to the ingredients in vaping products.