Health Benefits

Cost Management & Risk Mitigation

Protecting clients and members

Self-funded benefits can be an effective way to control rising healthcare costs. It is also a major responsibility for an employer. Fortunately, Trustmark has the experience and solutions to help our clients make self-funding work for them.
Protecting clients and members

Eligibility

We provide real-time eligibility updates to ensure eligible members receive the care they need when they need it and then work with employers to resolve potentially costly eligibility discrepancies. Reducing the number of ineligible dependents on an employer’s plan can result in thousands of dollars in savings.

High-Cost Services & Diagnoses

Some claims require extra attention. When claims come in for high-cost services, we take a closer look for things like:
  • Billing errors
  • Waste
  • Negotiated savings opportunities
It’s one more way we try to save money for employers and their members.

Prior Authorization

We work with employers to recommend prior authorization on specific services—such as chemotherapy and dialysis—to ensure members get the appropriate care in the most cost-effective setting.

More Protection Thru Reinsurance

Reinsurance, or stop-loss coverage, is a vital protection. Employers can rely on our team to help them find the best reinsurance coverage options for their plan from one of the A-rated stop-loss carriers we work with.

Cost Containment Case Studies

Our internal team of experts is always researching, analyzing, and providing clarity on the world of benefits. Watch this space for updates and check out our cost containment case study page for more.

 

Out-of-Network Discounts and Fee Negotiations

Modern healthcare doesn’t have to fit into a network to be affordable. We offer many ways for individuals to save on visits to out-of-network providers through a multi-tiered hierarchy of programs designed to reduce costs whenever possible.

Waste & Abuse Protection

We utilize cutting-edge technology to analyze historical claims for questionable provider billing patterns. We also use experienced waste and abuse-fighting experts to ensure claim dollars are going to valid claims, not bogus ones, putting a stop to ongoing waste and rooting out past abuse.

Hospital Bill Auditing

Our auditing helps catch costly errors and miscalculations in complex hospital bills. Through special processes, we scrub itemized bills, review doctors’ orders, and identify any billing issues, and then we work with the facility to resolve any questionable charges.

Subrogation Review

Recovering overpayments and other claims can bring big savings to a self-funded benefit plan. We scrutinize paid claims to find other parties that may be liable to pay for a specific claim, and we’ll work to help our clients recover any associated paid claims.

Reference-Based Pricing

What if hospital and provider pricing plans were clear, linked to actual costs, and easy to understand? Our reference-based pricing tools make that dream a reality. Watch our reference-based pricing video to learn more.

Other Products and Services

In addition to our claims and benefits administration expertise, we have a number of other solutions. Take a look: