CUSTOME SOLUTIONS

CUSTOMIZED HEALTHCARE SOLUTIONS

Our goal is to think outside the box and provide innovated solutions that make a difference. We recognize that many proven solutions for lowering healthcare costs and improving quality are not being fully implemented across the industry. Our independence allows us to prioritize and select strategies that serve the best interests of both the employer and the member then provide the expertise and execution needed to implement meaningful, cost-saving changes.

With over 50 years of combined healthcare experience, including more than 30 years in health insurance, we specialize in self-funding, consulting, claims administration, and data analysis for employer-sponsored health plans. We have successfully negotiated multi-million-dollar agreements with hospitals, physicians, and ancillary providers.Type your paragraph here.

CUSTOM PROVIDER NETWORKS
Not all provider networks are created equal—and many fail to continuously improve their discounts. On average, a tiered network can reduce plan costs by 14% or more. We strategically direct members to high-quality, lower-cost providers to maximize savings for both the plan and the member.

MEDICARE-LIKE RATES & REFERENCE-BASED PRICING
We offer Medicare-like rate solutions for Indian Tribal Entities and other self-insured employers. Our proprietary technology blends Medicare and market pricing to develop optimized reimbursement levels and strengthen your negotiating position.

FREE AND CLEAR PROGRAM
Elective surgeries and other medical procedures can be expensive and paying for large amounts out of your pocket and be frustrating. Our Free and Clear offers members the opportunity get their services paid with smaller out of pocket costs or 100%. Contact us to find out how our Free and Clear Program works.

BENEFIT PLAN CLAIM AUDITS
For self-insured plans, ensuring every dollar is spent appropriately is critical. With increased federal enforcement and over $17 billion in targeted recoveries, compliance is more important than ever. We audit 100% of claims for accuracy, ensuring alignment with your plan documents and stop-loss contract while maintaining full ERISA compliance.

LARGE CLAIM AUDITS & NEGOTIATION
Hospital claims have increased 25% to 40%, with high-cost claims accounting for 50% to 80% of total plan spend. Our clinical expertise, negotiation strategy, and proprietary auditing systems are designed to identify savings opportunities and reduce large claim exposure.

SUMMARY PLAN DOCUMENT (SPD) REVIEW & REWRITE
Federal agencies have intensified enforcement of the Affordable Care Act (ACA) and ERISA requirements, including routine group health plan audits. We review your existing SPD for compliance or develop a customized document tailored to your plan.

TRIBAL SOLUTIONS
We develop custom provider networks and establish competitive discounts for non-MLR services, including physicians, labs, and ancillary care delivering optimal pricing for non-hospital providers. We also customize and supplement Medicare-Like Rate (MLR) pricing with your selected providers to help direct care to higher-quality, lower-cost options. We offer flexible MLR pricing models, including a percentage of savings, per-claim fees, or per employee per month (PEPM) structures—allowing each Tribal entity to choose the approach that best fits its needs.

INSURANCE PAL
Insurance pal is a customer concierge service for your health plan members. Healthcare is difficult to navigate and employees are busy working. insurance pal assists them with making appointments, finding providers, scheduling surgeries, balance billing, obtaining member ID cards, helping with dental insurance and any other items that the employer offers to their employees. There is no AI involved. Every customer gets to speak to a live person and get customized help for their insurance questions.