December 2017

Take the waiting out of stop loss reimbursement

Some offerings in the marketplace advertise competitive turnaround timing when it comes to stop loss reimbursement—but when a carrier promises payment within days or hours, can you be confident that they mean within days or hours from the claim being paid?

With our Cigna Stop Loss automatic reimbursement, you can offer your clients a clear turnaround time expectation that lets them know when a stop loss reimbursement will be issued, as well as when funds should settle to their ASO bank account.

Why focus on the “from” event—in other words, the mechanism and timing for reimbursement—when comparing coverage? 

When it comes to bidding on stop loss coverage—there are a few different types of reimbursement timing you will see advertised and, oftentimes, the number of days for stop loss reimbursement turnaround actually refers to a period of time from receipt of paid claim reporting. So, what was advertised as a few days on paper can potentially add a month or more in practice.

When does the clock really start on stop loss reimbursement timing? It’s an important question to ask when comparing coverage.

If your client’s covered employees suffer serious illness or injury, a large claim could be very detrimental to their cash flow with a carrier that reimburses within days from receipt of paid claim reporting. What you really want to see, is a carrier offering stop loss reimbursement within days from the claim being paid. That way, each stop loss reimbursement has a chance to meet or beat the provider payment debit to your client’s account.

With Cigna Stop Loss automatic reimbursement, we make stop loss claim payment simple with no action needed on your part:

  • Our general service for payouts up to $150k offers quick turnaround—93% of claims are reimbursed within 48 hours of claim payment; 99% within 5 days.*
  • Our expedited service is automatically activated for reimbursements in excess of $150k, ensuring settlement to the client’s account before the health care professional payment is withdrawn or on the same day in most cases.
  • Clients receive advance email notification when reimbursement has been scheduled for large claims, which will indicate dollar amount and estimated settlement date.**

Automatic stop loss reimbursement from Cigna can protect your client in the event that covered employees suffer injury or develop serious medical conditions that would otherwise disrupt their cash flow. The cherry on top is that there is no action needed by you or your client.

You wouldn’t wait days, let alone a month or more, for your change when paying for your morning coffee or shopping at the mall—why wait for your “change” during a stop loss transaction?

To learn more about industry standards for reimbursement and how they compare to turnarounds from our dedicated stop loss team, please consult your Cigna Client Manager or reach out to to schedule an interactive training session. Cigna offers two stop loss training courses for continuing education credit.

Note: Availability is based on Stop Loss coverage for self-funded employer clients with more than 250 employees.

*Cigna analysis based on claims data from 01/01/2013–12/31/2013. December 2014.
**Stop Loss Reimbursement Notifications are issued for claims with medical payouts of $250k+.