HEALTH Claim COST CONTAINMENT SOLUTIONS

1. HEALTH Claim COST CONTAINMENT SOLUTIONS Presented by London Medical Management, Inc.

2. DISCUSSION • Health Claim Cost Containment Solutions • Unique combination of Health Claim Negotiations with Patient PALTM advocacy service • Single Point of Contact Model

3. Single Point of Contact • Effective management of patient intervention on a pre- and post-need basis • Single toll-free contact number • All calls triaged through Patient PAL nurses • Live transfers to: • Customer Service department of health plan partner • EAP program information and assistance • Human Resource and Benefits departments • Board Certified Physician • Professional health claims negotiators

4. Access to a healthcare professional 24 hours a day, 7 days a week • Toll free access line at 1-877-MED PAL 8 • Assisting in securing second opinions • Appointment scheduling with hard to access physicians • Access to “Centers of Excellence” A London Medical Management Company

5. Health Claim Negotiations • Assist in resolving errors in claim denials and/or billing issues • Correct any balance billing issues • Negotiate settlement and facilitate payment process • Negotiate non-covered health care services when possible • Work with billing department on behalf of client to arrange payment process

6. Out-of-network Claims: • No network affiliation • No discounts • In-network Claims: • UHC • CIGNA • Anthem BCBS • Humana • Aetna • TPA’s • Other health plans HEALTH CLAIM NEGOTIATIONS 3 Buckets of Claims • In-network Claims: • Secondary or Rental Networks • aka “Wrap” networks • PHCS/Multi-plan/Three Rivers/Interplan Etc. • Discount: 5% - 25%

7. HOSPITAL STOP LOSS PROVISION Protects the Hospital, NOT the Client ***Once Billed Charges reach the Stop Loss amount ($50,000 in this case), hospital Reimbursement reverts from Per Diem to a Percentage of Billed Charges (usually 40% discount) ***Example above: Average Daily Reimbursement is $7,200

8. Out-of-network Claims: • No network affiliation • No discounts • In-network Claims: • UHC • CIGNA • Anthem BCBS • Humana • Aetna • TPA’s • Other health plans HEALTH CLAIM NEGOTIATIONS 3 Buckets of Claims • In-network Claims: • Secondary or Rental Networks • aka “Wrap” networks • PHCS/Multi-plan/Three Rivers/Interplan Etc. • Discount: 5% - 25%

9. Pend: • ALL in-network claims that reach $50,000*** level • ALL in-network claims accessing secondary networks that reach • $10,000*** level • ALL out-of-network claims • All Claims must be pended BEFORE they are paid • ***Threshold levels may be adjusted to maximize client savings HEALTH CLAIM NEGOTIATIONS Process

10. CLAIM from TPA • UB 92/HCFA 1500 • ASC II File Format • In/Out of network • indication • Provider Contact • agreements are negotiated one • claim at a time HEALTH CLAIM NEGOTIATIONS Process • Provider Charges (Research) • based on geographic • location of the facility/provider • - Historical negotiations data • LMM Claim Fact Sheet • claim details extracted • from info provided by • TPA

11. Many negotiators relied on Ingenix as a benchmark for reimbursement of out- • of-network claims • Utilization of Ingenix UCR software resulted in a class-action lawsuit where • plaintiffs argued that Ingenix’s URC data underestimated historical charges • and systematically underpaid out-of-network claims. • Payers that have either paid settlements or are on the dock to do so: • Health Net • Coventry Health Care, Inc. • Aetna, Inc. • Blue Cross Blue Shield (several entities) • United subsidiaries • PacifiCare • United HealthCare WHAT IS COMPETITION DOING???

12. HEALTH CLAIM NEGOTIATIONS Claim Fact Sheet

13. HEALTH CLAIM NEGOTIATIONS Claim Fact Sheet

14. Negotiations for a Fortune 500 Company working with a nation’s leading health plan

15. **PLAN Allowable includes discounts available through associated wraparound networks

16. Single Point of Contact Model • Pricing based on PEPM model for self-funded • and fully insured plans • Health Claim Negotiations • Percentage of documented savings • No set up costs for the employer London Medical Management Fees

17. WHAT WE HELP YOU ACHIEVE • Decrease the total cost of health care through direct negotiations of individual patient claims • Enhanced benefit plan design with the addition of Single Point of Contact including Patient PAL program

18. Our Value Proposition • We assist insurers and employers to reduce the cost impact of large claims through direct negotiations with providers. We utilize the savings from these negotiations to help employees and their dependents navigate the complexities of the healthcare system through our Single Point of Contact Model including Patient PAL program.

19. Our Clients Include:

20. SUMMARY • Health Claim Cost Containment Solutions • Unique combination of Health Claim Negotiations with Patient PALTM advocacy service • Single Point of Contact Model

21. LMM Contact Info Corporate Headquarters Contact: Jack G. London, President/CEO Phone: 702-737-7555 Fax: 702-737-7504 Address: 11920 Southern Highlands Pkwy, Suite 103 Las Vegas, NV 89141 www.LondonMedicalManagement.com www.PatientPAL.org