RESPOND - Catastrophic Claims Management Program

As the severity of a claim injury increases, the medical portion of the claim costs increases exponentially. For the truly catastrophic claims, medical costs often exceed 90% of the claim file's total cost. As a result, catastrophic claims account for several billions of dollars in medical costs in the US every year, even though catastrophic injuries represent a small portion of all claim incidents. Consequently, controlling the medical costs on these files becomes critical to payers' overall financial results.

Catastrophic injuries require lengthy hospitalizations, extremely expensive therapies and medication, and other long term care. Unfortunately, sub-optimal medical outcomes and unnecessary medical costs often result, due to the limited experience of payers and medical professionals in the expert management of catastrophic cases. Further, due to the infrequent nature of catastrophic injuries, a large percentage of the medical expenditures associated with the injury are not addressed by state fee schedules or traditional PPO arrangements.

RISING's catastrophic claims management program, RESPOND, targets all aspects of medical cost management to achieve optimal catastrophic claims results for payers, employers, injured parties and their families. By integrating RISING's medical bill review, negotiations, medical management, and catastrophic care protocols, we are able to provide maximum control over medical costs associated with these highly complex and intricate cases. RESPOND specifically combines catastrophic case management nurses and care procedures with best in class medical treatment and advanced medical payment systems to impact total claim costs by an average of 40 - 50% in savings over the life of a catastrophic claim, while achieving better patient outcomes.

Through our involvement in thousands of catastrophic claims management cases, RISING's specialized catastrophic care team, early intervention and communication strategies, predefined action plans, negotiation tactics and expert bill review have helped produce the best possible results from the worst case scenarios.

Contact Us

If you are a primary carrier, reinsurance carrier or self insured employer and would like to learn more about RISING's catastrophic claims management program, please complete our Request for Information form and check the "Catastrophic Care Management" option.

If you interested in learning how RISING's RESPOND program can help you in your reinsurance treaty process, please contact us at: reinsurance@risingms.com.

For catastrophic care medical professionals who want to learn more about strategic partnerships with RISING, please click on the appropriate link: catastrophic nurse case managers / catastrophic care providers.