Medical Disclosure
To Provide Stop Loss Carriers and MGUs with a timely, comprehensive clinical assessment on an individual member regarding expected treatment plan, potential costs for next 12 months, diagnoses and prognosis.
American Health's role in the Medical Disclosure process is:
- To project potential medical and high-dollar pharmaceutical claims a member could accumulate over a 12 month period
- To project the potential for re-hospitalizations
- To provide a clinical prognosis
- To provide history and clinical status reports
- To review proposed the treatment plan and determine if it is within accepted standards of practice for disease and condition processes
- To identify experimental and/or investigational treatments and medications, including FDA approval status
Fast Facts
- Prompt acknowledgement of request and response
- Utilizes experienced Registered Nurse Case Managers
- Detailed reports identifying potential risk to assist underwriting in setting rates