Berkley Edge

Part of Your Team — Berkley Edge

Berkley Accident and Health is more than just a provider of great insurance protection. We’re a part of your team.

Your organization needs reliable protection. When a large claim occurs, you should feel confident that it won’t threaten your bottom line. With Berkley Accident and Health, your claims are protected by the resources of a strong, A+ rated insurer. Our strength and service can help safeguard your organization from health claims you can’t predict.

But insurance coverage is only part of why you should choose Berkley. We put risk management at the center of everything we do. With our large claims expertise, we can become an extension of your team. When you need a safety net, you can count on Berkley Accident and Health.

What we do

We help our clients to lower the cost of catastrophic claims, while preserving quality care. We have on-staff clinical experts who can become a part of your team and help identify large claims, share resources and knowledge, and recommend solutions to control costs.

Our clinical risk managers have 10 to 20+ years of clinical, case management, and insurance experience. They are an invaluable source of knowledge, arming our clients with the information they need. At no additional cost to our clients, they can:

Provide access to negotiation for high-dollar claims
Research rare medical conditions, emerging treatments, and new medical devices
Recommend transplant Centers of Excellence facilities and perform contract analysis
Provide consultations with case managers on complex and rare medical conditions

Perform large claims forensics, based on historical claims data and projections of future treatments
Estimate cost of current and future care
Validate patient care plans
Perform vendor gap analysis

How do we help?
Our team of clinical specialists have extensive experience helping companies with catastrophic diagnoses and high-dollar claims and can connect clients to the appropriate vendors and services.

The result?
We have helped our clients save millions in hard- and soft-dollar claim costs. Every year, we work with hundreds of clients to analyze and bring down healthcare costs. These savings directly impact our clients’ first-dollar costs, plus help to lower their claims experience, which in turn, slows their annual premium increases.

Real Life Examples

Case Study #1 – Contract Comparison Yields Transplant Savings

The problem: A Stop Loss client’s administrator notified our team that a patient had just been approved for an autologous stem cell transplant, a potentially costly treatment.

The solution: We examined the rates provided by the administrator and provided a detailed contract comparison. We recommended a transplant Centers of Excellence network with lower overall projected costs, even in the worst case scenario, and arranged a conference call with both the administrator and client to discuss her findings. The client agreed, and we helped them execute a contract with the Centers of Excellence network, lowering the claim by nearly $30,000.

Case Study #2 – Removing Barriers to Savings

The problem: A patient was scheduled to have a stem cell transplant soon, but pricing and access to the facility were still up in the air, which could result in a potentially high cost claim.

The solution: When we discovered that network discounts were not in place and the client’s administrator did not have access to the chosen hospital, she introduced the idea of using a transplant Centers of Excellence network. Initially, the administrator hesitated, because the network belonged to a competitor and it was doubtful that the administrator would be given access. We overcame that objection and helped the administrator to make the patient referral and sign the transplant contract. We helped the patient have a transplant at the chosen hospital using the Centers of Excellence network, resulting in nearly $94,000 in savings.

Case Study #3 – Routine Check Leads to Rx Savings

The problem While working with a client on another issue, our Clinical Risk Manager noticed that a patient was taking two tablets of an extremely expensive medication.

The solution: After some research, we told the case manager that a single, less expensive tablet was available in the same dosage. The case manager talked to the physician and changed the prescription, resulting in significant savings for both the client and the patient, who was paying 30% out-of-pocket for this costly drug.

Who we work with

We often see the greatest savings when we recommend specialty service providers. Specialty services can target specific types of claims, such as:

Transplants
High-risk maternity and neonatal care
Multiple trauma and burns
Dialysis (More)

Rare diseases and disorders, such as hemophilia
Oncology
Specialty pharmaceuticals
Additional services at-a-glance

We also can recommend providers for:

Board-certified physician review
Certified case management
Bill review and negoitation
Patient advocacy programs