June 2018

Take the Waiting Out of Stop Loss Reimbursement

Some offerings in the marketplace advertise competitive turnaround timing when it comes to stop loss reimbursement. However, 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?

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 several different types of reimbursement timing you'll see advertised. Often, the number of days for stop loss reimbursement turnaround actually refers to a period of time from receipt of paid claim reporting (The stop loss payment? Or the underlying claim payment?).  A time period that 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 the client's cash flow if they have a carrier that reimburses within days from claim reporting. The ideal scenario is when a carrier offers 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.

You wouldn’t wait days, let alone a month or more, for your change when buying your morning coffee. Why wait for your “change” during a stop loss transaction? Automatic stop loss reimbursement (from claim payment) can protect your client in the event that covered employees suffer injury or develop serious medical conditions, creating costs that would disrupt your client's cash flow.

With 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. Plus, there is no action needed on your part:

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reimbursements in excess of $150k, ensuring settlement to your client’s account either before the provider payment is withdrawn or on the same day, in most cases.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

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 CignaStopLoss@Cigna.com. We invite you to schedule an interactive training session, as well. 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 500 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+.