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Provider stop loss coverage is insurance that provider groups and/or facilities purchase in order to transfer their risk for catastrophic patient expenses to an insurance company. It is accomplished by purchasing a pre-determined stop loss deductible from an insurance company. Example: a $50,000 specific stop loss deductible is purchased by the Provider/Facility from Insurance Company ABC. If they have a claim that exceeds $50,000 for any patient, then they can submit the excess claims and be reimbursed by ABC.
Any entity that receives capitation from a payer to assume partial or full risk for patient population medical expenses needs provider stop loss coverage.
No risk-bearing entity who is prudent assumes total risk, as it can be potentially greater than the risk-taker’s ability to pay. This is why even the largest insurers in the world have similar coverage themselves and transfer risk to other insurers.
First, ask the broker how long he/she has personally been placing provider stop loss coverage. Then find out how many clients they handle, and what the tenures of those clients are.
Who you work with is paramount, as there are many things that can go wrong with placing and designing provider stop loss coverage. You want a professional who works with this coverage weekly.
Click here and fill in the quote form, or feel free to call 1-888-478-6756.
Since 1994 – HCP’s top priority is finding clients the best possible coverage and terms at the lowest possible cost. HCP is a certified diverse (MBE & WBENC) insurance brokerage.
