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Provider Stop Loss Secrets Revealed

By: Matt Gracey, Guest Contributor

Are you in a capitated contract or thinking about one?

Negotiating capitated contracts is becoming more common with many medical groups these days.  With a dizzying array of data points that need to be examined and negotiated with the payors one huge item in the equations of at risk contracts is the reinsurance coverage, and boy is there some gold in this seemingly small line item among all that data!

Also called Provider Stop Loss (PSL) insurance, this coverage is quite expensive even for medium sized medical groups because of the amount of risk involved.  But here is the secret that many payors try to hide from doctors: you don’t have to purchase the reinsurance coverage through the payors as they often lead you to believe! By striking this expense out of a payor contract and purchasing PSL from the open market we are seeing up to 25% savings… very serious dollars given the millions this coverage runs even in the lower level contracts. A word of caution though: given the profits the payors can make by up charging medical groups for PSL in capitated contracts many payors are seeing PSL coverage as new profit centers and are hiding the costs even deeper in the complex spreadsheets of numbers.

Find out more about Danna Gracey and the potential savings you can realize by emailing [email protected] or by calling 800.966.2120.