Stop-Loss

Staying Within Insured Limits

Stop-Loss Carriers Are Getting Squeezed

Stop-loss carriers are pinched harder than anyone else when it comes to healthcare costs. You never get to take advantage of quality Managed Care rates. You don't get to determine on your own what will be paid and won't be paid.

A PPO contract with a hospital may offer a great rate for those hospital services up until they pierce an outlier clause, usually around $75,000, and the quality pricing goes away. Once it goes beyond that outlier point, then they go back to a discount off billed charges, which sometimes doubles or even triples the cost of the service. For a stop-loss carrier, you may never get a chance to take advantage of the better rates that are below that outlier clause. You are almost always paying claims against a discount off billed charges when it goes into that hyper-faced double or triple service.

By having AMPS as part of their contract, the stop-loss contract with the employer group and with the TPA, they can guarantee that AMPS is going to be in there and we're going to reset that payment level so that they get the same kind of savings that the employer gets or the TPA gets on the smaller claims.

There Is Another Way

By having AMPS as part of their contract, the stop-loss contract with the employer group, and with the TPA, they can guarantee that AMPS is going to be in there and is going to reset that payment level so that they get the same kind of savings that the employer gets or the TPA gets on the smaller claims.

AMPS Driven Solutions

1

(OON) Out-Of-Network Solutions

AMPS offers multiple solutions to drive significant savings on out-of-network bills, including direct negotiations and reference based repricing.

2

(MBR) Medical Bill Review

AMPS Medical Directors perform line-by-line facility claim reviews to correct mistakes and ensure accurate and reasonable pricing. AMPS MBR clients save an average of $685/employee annually.

3

(RBR) Reference Based Reimbursement

Stop over paying and replace your PPO network! Our Care Connex program combines RBR, Healthcare Navigators, member advocacy, and primary care telemedicine to help you save 20% on health expenses while providing high quality benefits and care. AMPS RBR clients save an average of $2,600/employee annually.

4

(DPC) Direct Provider Contracting

We can add critical providers to your benefits program and significantly decrease your Plan medical spending and member out-of-pocket costs.

Still Have Questions? Contact an AMPS Client Representative