Cost Containment Practices

We understand that excessive or inappropriate medical treatment can be potentially detrimental to patients as well as costly for individual clients and employers alike. For this reason, we have put a range of processes and checks in place to ensure that the cost of medical care is managed appropriately.

Here are just some of the cost containment measures we have implemented:

Medical services and claims team

Individuals within the Medical Services and Claims Team are allocated to specific geographical territories, allowing them to develop stronger relationships with the medical providers in those regions. This experience places them in a good position to review and challenge the in-patient treatment path and tariffs proposed by medical providers, ensuring that the proposed treatment is appropriate, necessary and that costs are in line with the usual and customary charges for the region.

Fraud prevention

Our specialist fraud detection unit is responsible for monitoring and reporting suspected fraudulent activity. Our state of the art system, supported by our on-the-ground medical experts, ensures that cases are detected early and losses are minimised.

Network management strategy

We are not restricted to any exclusive medical provider network arrangements. This strategy allows us to harness the combination of networks and the most appropriate means of access, to best meet the needs of each group client in terms of cost containment and customer service. It also means that insured members are free to select their preferred medical providers (subject to the wishes of our corporate clients and international organisations in relation to their staff).

Pre-authorisation process

Pre-authorisation is when you notify us in advance of certain proposed treatments and benefits. Submission of a Pre-authorisation Form is required before any in-patient treatment, medical evacuation, oncology treatment, rehabilitation or routine maternity. Each Pre-authorisation gives us the opportunity to ensure that treatment is appropriate as well as the chance to negotiate additional savings.

Provider services team

We recognise that strong medical provider relationships are essential to the ongoing delivery of effective cost containment and efficient customer service. For this reason, our Provider Services Team is in regular contact with our medical partners across the globe. Territory visits are often made by the Provider Affairs Team in order to reinforce these important relationships and to supplement contact made by telephone.

Claims reports

Our large group clients are provided with regular medical claims reports e.g. claims by benefit, by country, by size, by insured type/age/sex and by insured population. This allows clients to monitor (and forecast) group scheme claims performance. Separate reports which detail any high claims are also made available to Group Scheme Managers. Our claims reports can be scheduled to be issued automatically at regular intervals to the client contact person, without the need for manual intervention.