Managing Health Care Risks
We offer reinsurance products for HMOs, health plans and provider organizations. Products include:
Health Plan Reinsurance – We provide commercial, Medicaid and Medicare HMOs with solutions to help mitigate catastrophic exposure and offer tools and services that help clients address a wide range of financial risk areas.
Provider Excess Insurance – We analyze coverage needs, claims experience and financial risk to assist provider organizations in helping to minimize their financial exposure from catastrophic claims.
Delivering Cost-Saving Solutions
Our HMConnects™ program provides specialty services and solutions that help protect our clients from the financial losses associated with catastrophic medical expenses. To achieve this, we bring together resources designed to complement existing bill reviews and controls without taking over the management of a clinical case or disrupting the timely adjudication of a claim.
Catastrophic claims management often requires multi-disciplined methodology. Using a clinically based approach to financial management, we can implement HMConnects™ services to assist in a wide array of situations. Our HMConnects™ program supports the specific needs of each client – before and after a claim is presented for payment.
Core HMConnects™ program offerings include:
- Negotiation for single cases or out-of-area claims
- Independent bill reviews for financial payment accuracy, medical necessity and treatment protocols
- High-cost case review, including clinical necessity assessment
- Review of specialty pharmacy dosing and supplies (evaluation of number of units, cost of units, etc.)
- Introduction and evaluation of transplant networks
- Services addressing fraud, waste and abuse
Discover more about our program, products and services in Managed Care Reinsurance: Guarding the Financial Health of Plans and Providers.
In all states except New York, coverage is underwritten or reinsured by HM Life Insurance Company, Pittsburgh, PA, or Highmark Casualty Insurance Company, Pittsburgh, PA, under policy form series HM PEL 1105, HC PEL 1105, HMP PEL (08/19), HMP PEL (09/20), HML 1105 ELR, HMC 1105 ELR, HM 1005-ELR or similar. In New York, coverage is underwritten under policy form series HMNY PEL 1105 or similar or reinsured by HM Life Insurance Company of New York, New York, NY. The coverage or service requested may not be available in all states and is subject to individual state approval. Reinsurance agreements only reflect a form number when required by applicable state law.