Don’t Let Mega-Claims Break the Bank

PMBA's cost containment is even more effective on six- and seven-figure claims

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PMBA Plan Sponsor Protection

Mega-Claim Protection

Mega-claims that breach stop-loss policy deductibles are a mega problem. Mega-Claim Protection ensures that when these massive claims hit, our clients pay as much as is legally required and not a dollar more.

Large and mega-claim protection

Under ERISA, your group's Summary Plan Description (SPD) is the legal document that governs everything about your Plan. PMBA’s wealth of legal, regulatory and claims expertise helps our clients develop the best possible SPD. A PMBA SPD protects your Plan’s fiduciary interests and secures the legal basis for your Plan to pay claims at the lowest rates available, protecting the financial health of your Plan and its members.

What PMBA Will Do for You:

Perform comprehensive line-level analysis of itemized bills
Exclude unpayable lines and unbundled services
Audit the claim for fraud, waste, abuse and overbilling
Ensure the claim’s compliance with the terms of the Plan SPD
Reprice the analyzed claim to the lowest rate justifiable under PMBA PSP

PMBA’s claim protection services do double duty

Expert oversight and auditing, particularly of high-dollar claims, are fundamental to Plan Sponsors upholding their fiduciary duties mandated by ERISA compliance. Get relief from high-dollar claims!

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  • Saving our payers millions of dollars

  • Providing Plan Sponsors with an essential compliance service.