PROBLEM: Claims submitted after the Treaty Year had expired.
BACKGROUND: The Public Health Emergency allowed providers an extended time to file claims. A DuNord client received a demand letter from a law firm for a hospital regarding claims denied several years earlier, and way outside their reinsurance treaty.
SOLUTION: DuNord believes in long-term relationships between clients and reinsurers. This reinsurer had a 7+ year relationship with the client. When a settlement was arrived at, DuNord appealed to the reinsurer for an exception and the reinsurer agreed to reimburse for claims they had no legal obligation for.
Long term reinsurer relationships are best.
PROBLEM: An in-network claim with minuscule discounts.
BACKGROUND: A client called to confirm reinsurance coverage for a procedure. Additional questioning determined that the $2.2
million claim, which had occurred in-network and had been processed but not paid, was scheduled to be paid the next day. The claim occurred at a wrap network provider with minuscule discounts.
SOLUTION: DuNord requested a hold be put on payment and engaged a negotiation vendor who obtained approval to reduce the claim by an additional $800,000.
If you try, sometimes amazing results can be achieved.
PROBLEM: In-network, but low discounts.
BACKGROUND: During a monthly cost containment call, it was learned that twin premature babies were born at an in-network (wrap) Children’s hospital.
SOLUTION: DuNord contacted a negotiation vendor, who increased the discount from 7% to 40% off billed amounts for both $1.1+ million-dollar claims, saving both the reinsurer and the client money.
If you try, superior results can happen.
PROBLEM: No beds available.
BACKGROUND: A client had a member with an emergency, premature delivery. No beds were available at the local Children’s hospital.
SOLUTION: DuNord called a Children’s hospital in the neighboring state to confirm they would accept Medicaid rates and had beds available. The member was airlifted to that Children’s for delivery and NICU care.
DuNord tries harder.
REINSURANCE, MADE SIMPLE
“Our health plan has been working with DuNord Reinsurance Consulting for the past two years. In our experience, Brad and Vaughn [DuNord staff] are timely in their responses, excellent at follow through, and collaborative in so many ways. We have experienced firsthand their genuine interest in the overall success of our organization. They have done a great job of obtaining multiple quotes, reviewing reinsurer contracts, and then sharing their expertise as we evaluate the various alternatives. DuNord then provides a steady stream of service and guidance throughout the year.”
– JOHN L.
Chief Operating Officer
“Highly recommend DuNord Reinsurance Consulting. They always deliver according to agreed upon timelines and have extensive contacts with all major reinsurers. Very responsive and supportive with follow-up questions and issues. Excellent resource, even for items not directly in the original scope of services engaged.”
– JOHN B., FSA, MAAA.
Director of Actuarial Services
“We have worked with DuNord for many years and enjoy their expertise in the health insurance industry, connections to other payors, and relationships with the reinsurance carriers. Our needs are non-traditional, and DuNord has helped us with appropriate products that fit our unique circumstances. As market conditions change, DuNord has been in lock step with us to successfully manage our risk.”
– MARY Q.
Senior Vice President, Finance
“Our relationship with DuNord is one that goes beyond a yearly transaction of reinsurance renewal. Brad and the team are looking out for us year-round, not only looking at our reinsurance performance, but also looking for other opportunities to expand our offerings and find other solutions that may help us improve our business. This greater partnership allows me to recommend DuNord to others looking for solutions for reinsurance!”
Co-founder & COO
“We have come to rely on the DuNord team not only to structure the most advantageous contracts, but also for their technical expertise and advice when we encounter large, complex claims. They have provided wise counsel on matters as diverse as vendor selection and networks. Highly recommend”
Co-founder & COO
“Thank you for the reinsurance program information. Your documents and explanations are excellent. You have no idea how refreshing it is to have an explanation that allows me to have understanding without getting frustrated and to the point where I have to demand the legal contract and figure things out for myself.”
– B.A., FSA
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