Our ability to pay claims fast — our goal is to process claims within three business days — can help alleviate the employer’s financial burden and possibly obtain valuable discounts on catastrophic cases.
How long does it take the average stop loss provider to process and reimburse a claim?
“Our customers tell us that other companies take two to four weeks to reimburse claims,” said Marien Diaz, assistant vice president of Group Benefits in Symetra Life Insurance Co.’s Miami, Fla., office. “But we pride ourselves on reimbursing eligible claims promptly and fairly, as long as we are not paying ‘retail prices.’ on claims.”
When it comes to paying claims, speed matters. So much so that hospitals, physicians and other health care providers are often willing to negotiate discounts in exchange for speedy payments.
“A lot of individual stop loss claims are catastrophic in nature. An organ transplant or premature newborn claim may cost a half million dollars or more,” Diaz explained.
“Even though a stop loss policy is a reimbursement contract, there’s a provision in our policy that may help advance reimbursement for a catastrophic illness so the employer doesn’t have to shoulder the financial burden of funding a large claim up front. Plus, working together with TPAs, we may leverage the advanced funding advantage to negotiate discounts with the provider. The advanced funding feature of the policy is available to all our customers at no cost.”
Here are three ways to make sure the employer gets the claims reimbursement quickly:
- Sign up for EFT. For employers who want to receive their claim reimbursements fast, electronic funds transfer (EFT) is the speediest solution. EFT eliminates the need to cut and mail a check, which can add up to a week to the process. Instead, claims reimbursements are directly deposited into the employer’s account on the second day following the completion of the claim audit. Plus, we keep TPAs in the loop by faxing a copy of the reimbursement explanation of benefits the day before the deposit is made.
- Fax claims. Another way to speed up reimbursements is by faxing the paid claims report along with the reimbursement request to the stop loss regional claims office
 in your area.
- Include all the important information. Also, TPAs should watch for missing information that could slow down the claim reimbursement. One of the most common problems is missing eligibility documentation that confirms whether or not a former employee is still eligible for coverage under the underlying self-funded plan.
We encourage our policyholders to take advantage of the EFT claim reimbursement feature. To sign up for EFT, call the stop loss claims office in your region (also see box). To request advanced funding, use the Advanced Funding forms available online.
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