Health Benefits
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.
Minimizing Risk and Exposure
Risk comes in many shapes and sizes, but we’ve seen it all before—and we have the experience to help our clients avoid it whenever possible.
Launching a self-funded health benefit plan means taking on the risks associated with all of the plan’s claims. We have the solutions employers need to help them minimize those costs and mitigate their risk by managing:
- Plan eligibility
- High-cost services and diagnoses
- Prior authorization
- Out-of-network referrals
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
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.
Managing Costs With Edge
Edge is our complete cost management package, with comprehensive solutions that go above and beyond for our clients. By helping to make sure money is only spent where necessary and reducing waste, our clients see significant savings.
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.
Network Access and Alternatives
With access to dozens of national, carrier-based, and regional networks, we can connect individuals with quality providers and deep discounts on healthcare services. We examine an employer’s population to find the right network or combination of networks for their people so they get the best possible discount.
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:
Stay in touch with Health Benefits
Self-funded health plan administration provided by Trustmark Health Benefits, Inc.