The stop loss environment has never been more challenging than it is today. Pricing volatility.
Larger and more complex claims. Increased frequency of claim denials and reimbursement uncertainty.
Provider billing errors. Lasers and exclusions. Gaps in coverage. Greater exposure to liability risk and litigation.

A partner that has the depth and breadth of specialized stop loss expertise and complex claim solutions will help you
meet the demands that you face. Point6 Healthcare will partner with you to create competitive advantages so that
you can increase client retention and win more.

Point6 Healthcare brings actionable and integrated solutions focused on the 0.6% of the employee population
that is driving 35% of employer healthcare expenditures.

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  • We leverage over $1B in annualized Stop Loss premium.
  • We purchase 8% better than the market.
  • We give you access to high-quality carriers, additional market capacity and "best practice" policy terms that lower premium cost and reduce claims payment uncertainty and E&O risk liability.
  • We add clinical underwriting expertise to our sophisticated marketing process that results in better outcomes for our clients.
  • We provide technology enabled solutions that integrate with your systems and reduce your overall cost of resources.
  • We implement streamlined and automated processes that reduce errors and result in “Repeatable and predictable” outcomes.
  • We leverage our vast roster of specialized stop loss and complex claims management resources across our entire book of business to complement and deepen your "bench" and eliminate your need to manage staff capacity during "seasonal peaks".
  • As a stop loss and complex claims management specialty practice, we have built a depth of experienced resources with the comprehensive expertise unavailable to even the largest TPA.
  • Our client service dashboards allow you to track workflow and case status in real time.
  • We produce comprehensive stop loss reporting packages that arm your market-facing teams with a risk narrative that tells the full story.
  • We provide you access to meaningful metrics and data that facilitate your management decisions.
  • We train your sales teams and offer ongoing sales support to ensure that every competitive advantage is recognized during the pursuit process.
  • Our integrated and experienced team of doctors, nurses, coding specialists, underwriters, actuaries and attorneys change the market and work relentlessly on your behalf to ensure that all claims savings are realized.
  • We share our override and contingent claims cost savings revenue with you.

Our Services

CLAIMS MANAGEMENT

  • Ongoing claims tracking
  • Monthly report monitoring
  • Timely claim reimbursement
  • Year-end claim reconciliation

CLINICAL REVIEW

  • Track large claimants
  • Track group trends
  • Current education
  • Treatment education
  • Laser validation
  • Laser reference

COST REDUCTION

  • Verify site of care
  • Review pharmacy utilization
  • Alternative treatment methods
  • Cost efficiency and alignment

EMPLOYER STOP LOSS PURCHASING PROGRAM

  • Rate predictability
  • "Best in Market" policy terms
  • Proprietary Disclosure Risk Reduction
  • Aggregate pooling program
  • Fully insured conversion solutions
  • Captive Strategies
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0.6% of the employee population accounts for 30% of employer healthcare expenditures.