Health Insurance Industry Issues and Legislation

A healthcare plan achieved total net savings of $750,524.79 (90.1% reduction) on an ESRD dialysis claim for a 56-year-old male patient by leveraging H.H.C. Group's innovative Reference-Based Pricing strategy. Read more to see how our transparent, predictable cost-containment solutions protect payor budgets and ensure fair reimbursements while preventing balance billing.

H.H.C. Group proudly announces the results of its annual client satisfaction survey. The results highlight H.H.C.'s continued success as a trusted partner for payors navigating in- and out-of-network medical claims and workers' compensation bills, especially high-cost line-item charges.

H.H.C. Group proudly announces achievement of the globally recognized ISO 9001:2015 certification with the expert guidance of ISOP Solutions. This certification validates H.H.C. Group's steadfast commitment to operational precision, compliance and delivering exceptional value to its clients.

H.H.C. Group proudly announces a groundbreaking case study that underscores the value of its innovative flat-fee approach to dialysis claim review. The study demonstrates how HHC's reference-based pricing (RBP) model enabled a healthcare plan to achieve an impressive 90.1% savings on a high-cost End-Stage Renal Disease (ESRD) dialysis claim—delivering over $750K in net savings.

Nearly 80% of employers view catastrophic healthcare claims—those exceeding $500,000 and sometimes reaching up to $4 million—as a major threat to their benefit plans. Brokers are advised to take proactive strategies to help employers mitigate this risk: implementing hyper-personalized wellness programs, scheduling timely interventions during peak business cycles and leveraging real-time benefits technology to drive cost savings and enhance long-term employee well-being.

Cigna's CFO warns that rising costs from expensive specialty drugs like Keytruda and increased inpatient surgeries for critical conditions are set to drive stop-loss renewal prices higher in 2025. Last quarter, these cost pressures pushed claims-to-premium ratios 4 to 7 percentage points above expectations, forcing adjustments that will affect employer renewals. Cigna plans to counter these challenges through balanced pricing, affordability initiatives and improved operational efficiencies.

According to a recent KFF analysis reported by Axios, nearly 20% of claims submitted to Affordable Care Act marketplace plans were denied in 2023, with some insurers rejecting up to 33% of claims. This high denial rate—especially for out-of-network services—creates significant challenges for consumers trying to manage their medical expenses.