* National individual and small group medical carrier
Sold business in 44 states, with claims in all 50 states and other territories
$327m in submitted OON charges for 121,437 priced claims
$226m in savings under ClearHealth program
69.2% gross savings on priced claims
Over 67% net discount after negotiating balance-billing inquiries
*** National large third party administrator with multi-millions of covered members
Uses ClearHealth “Negotiation” services to augment other network and non-network discounts in a unique model to negotiate only above a certain threshold on large claims
$165m
submitted total charges for 3,533 claims
Requirement to negotiate, on average, below 40% of billed charges
17%
success rate on an excess discount with an average discount of 72%
$17m
in excess savings over and above existing discounts
Short-term medical plan using a conventional national PPO network
$34m
in submitted total charges for 26,544 claims
$26m
in savings under ClearHealth program
77.3%
gross savings across all claims
Regional third party administrator, largely out-of-network but some PPO Replacement
$41m
in submitted total charges for 70,582 claims
$24m
in savings under ClearHealth program
58.4%
gross savings across all claims
** National privately held multi-line carrier with self-funded and short-term health plan options
Create a non-network “PPO Replacement” plan to pay reasonable rates to providers
Has in-force of > 20,000 covered members on PPO Replacement product since January 2018 launch
$76m
in submitted total charges for 69,105 claims
$53m
in savings under ClearHealth program
69.1%
gross savings on priced claims
Over 62%
net discount after negtiating balance-billing inquiries
Smaller regional third party administrator, largely out-of-network, but some PPO
$9m
in submitted total charges for 15,204 claims
$5.6m
in savings under ClearHealth program
63.5%
gross savings across all claims
National third party administrator, largely out-of-network, but some PPO Replacement
$161m in submitted total charges for 159,001 claims
$103m in savings under ClearHealth program
63.9% gross savings on priced claims
* Client’s one-year snapshot of data
** Client’s historical claim summary
*** Client’s 2018 claim data
National health plan offering self-funded and PPO Replacement plans
$251m
in submitted total charges for 202,589 claims
$152m
in savings under ClearHealth program
60.7%
gross savings across all claims
* Client’s one-year snapshot of data
** Client’s historical claim summary
*** Client’s 2018 claim data