Medical Disclosure

Provides Stop Loss Carriers and MGUs with timely, comprehensive clinical assessments on an individual member regarding expected treatment plan, potential costs for the next 12 months, diagnosis, and prognosis

We all know that 80% of health care dollars are spent by 20% of the population. As the preferred vendor among multiple stop-loss carriers, American Health provides Medical Disclosure services to evaluate claim risk, project potential for re-hospitalization, and provide clinical prognoses to stop-loss carriers and MGUs.

Cases may be submitted for Medical Disclosure review or referred via automatic triggers built into our integrated programs. Services help to project the potential high-dollar claims a participant could accumulate and identify savings opportunities to lessen the burden and financial impact of illnesses and chronic conditions among plan members.

Comprehensive Reporting and Flexible Program Options

All reviews are conducted by a Nurse Case Manager within three business days of receipt. Detailed claim risk reports include a medical history, clinical status, treatment plan, recommendations, and opportunities for cost savings. Case Management clients may view reports online 24 hours a day, 7 days a week via American Health's easy-to-use EZ Access program. Flexible service options allow clients to purchase Medical Disclosure services alone or in conjunction with our URAC-accredited Case Management program.

  • Timely, comprehensive clinical assessment and prognosis projections based on patient history
  • Estimating the potential high dollar medical and pharmaceutical claims a member could accumulate within the next 12 months
  • Reviewing proposed treatment plan and determining if it is within acceptable standards of practice for disease and condition processes
  • Identifying experimental and/or investigational treatments and medications, including FDA approval status

To learn more about American Health's Medical Disclosure program, please call us at (866) 614-4244 or send an email to marketing@AHHinc.com.