High-Cost Claimant Management
Proactive support for complex health situations
Dedicated coordination for employees facing serious diagnoses and intensive care needs
Why does high-cost claimant management matter?
5.0 Google Reviews
The top 10% of claimants typically drive 50%+ of healthcare costs. Without active management, complex cases spiral—more hospitalizations, complications, and costs that could have been prevented. Weltrio provides dedicated support for employees facing serious health challenges.
We got it.
Thank you for contacting us.
We’ll get back to you as soon as possible.
See where your benefit plan is leaking
Find out what gaps exist — and what you can do without changing your plan.
We'll show you where money is leaking, risks are growing, and what you can fix within your current structure. No pressure to change brokers, carriers, or benefit design. Just clarity.
- Gap analysis based on your actual plan structure
- Clear findings you can share with your broker
- Recommendations that layer on — no disruption required
Complex Case Management
Dedicated support for employees facing serious diagnoses. We coordinate care across multiple providers, ensure treatment plans are optimized, and serve as an ongoing advocate through complex treatment journeys.
Chronic Condition Programs
Specialized support for diabetes, hypertension, heart disease, and other ongoing conditions. Our programs help employees manage conditions effectively, reducing complications and costs over time.
Birth & Maternity Support
Navigation through pregnancy, delivery, and postpartum care decisions. We help expecting parents understand options, plan for delivery, and navigate the healthcare system during this important time.
Surgical Pre-Authorization Support
Ensuring proper approvals and pre-negotiating procedure costs before surgery. We prevent surprise denials and unexpected bills by handling authorization logistics proactively.
What is High-Cost Claimant Management?
High-Cost Claimant Management encompasses the specialized services that support employees facing serious health conditions, complex diagnoses, or intensive care needs.
These situations require more than routine care navigation. They require dedicated case management, coordination across multiple specialists, ongoing advocacy, and careful attention to both clinical outcomes and cost optimization.
Services include complex case management, chronic condition programs, birth and maternity support, surgical pre-authorization, and workers' compensation integration.
Why Does Proactive Management Reduce Costs?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
High-cost claimant management provides intensive, personalized support for complex health situations.
Case Identification
We identify employees facing complex health situations through claims patterns, clinical alerts, or direct employee contact.
Case Manager Assignment
A dedicated case manager is assigned who serves as the employee's ongoing point of contact and advocate throughout their health journey.
Care Coordination
The case manager coordinates across all providers, ensures information flows, monitors for issues, and helps navigate treatment decisions.
Ongoing Monitoring
Support continues as long as needed—monitoring progress, adjusting coordination as situations evolve, and celebrating improvements.
When Is High-Cost Management Activated?
High-cost management activates for:
• New serious diagnoses (cancer, heart disease, major illness)
• Planned major surgeries and complex procedures
• Pregnancy and childbirth (upon notification)
• Hospital admissions and complex discharges
• Chronic conditions with increasing complications
• Any situation where dedicated support would benefit the employee
Employees can also self-refer by contacting Weltrio when facing complex health situations.
Where Does High-Cost Management Apply?
High-cost claimant management applies wherever employees receive care:
• Local community hospitals and specialists
• Regional medical centers for complex care
• Academic medical centers and centers of excellence
• Home care settings for post-hospital recovery
• Anywhere care coordination is needed
We coordinate across all settings to ensure continuity.
Who Qualifies for High-Cost Management?
Employees with complex health situations qualify for dedicated management:
• Those with new serious diagnoses requiring multi-specialist care
• Employees with chronic conditions showing complications
• Pregnant employees and their partners
• Anyone facing major surgery or procedures
• Employees with multiple simultaneous health issues
• Family members facing complex health situations
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
Is this the same as telemedicine?
No. Clinical support provides guidance and triage, not diagnosis or treatment. We help employees decide when and where to seek care.How many nurses will be assigned to our company?
Assignment depends on your company size and typical utilization. Smaller companies may share a primary nurse with backup coverage. Larger organizations get dedicated teams. Either way, employees experience consistent relationships with clinical professionals who know them.Who answers calls in the middle of the night?
Board-certified nurses from your Weltrio clinical team. We staff night shifts with experienced nurses who have full access to your company's benefits information and employee interaction history. It's not an outsourced answering service.What protocols do nurses use for triage?
Our nurses use evidence-based clinical decision support protocols developed from emergency medicine and primary care best practices. These protocols are regularly updated based on current medical guidelines and are customized for telephone/virtual assessment settings.How much does an unnecessary ER visit actually cost?
Average ER visits cost $2,200 or more—even for minor issues. Add lab work, imaging, or specialist consultation and costs climb quickly. The same conditions treated at urgent care typically cost $150-300, and telehealth visits run $50-75.
