Frequently Asked Questions.

Answers about our self-funded solution, how we work with our clients, our partners and more.

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What does Maestro Health do?

Maestro Health is a tech-enabled third-party administrator (TPA) for employee health and benefits. We work with employers and their trusted advisors to administer self-funded health plans. By blending administrative services, clinical care management and cost management, we help employers optimize their benefit plans to drive better outcomes at a lower cost. When partnering with Maestro Health, employers can save money on healthcare and focus on what really matters—their people.

What is a self-funded health plan?

A self-funded health plan is a health plan model where the employer pays for healthcare coverage directly instead of using an insurance carrier. This includes paying claims, defining networks and repricing strategies and taking on the risk of the claims associated with their plan design.

What sets Maestro Health apart from other TPAs?

We have several differentiators that separate us from our competitors. Here’s a look at how we’re different:

  • Innovative network and repricing solutions. Our team works with you to manage your healthcare costs with strategies designed around your bottom line and your members.
  • In-house clinical care management. Our multi-disciplinary clinical team uses a tech-enabled approach to provide acute and chronic care management and 1:1 coaching, developing relationships with members to provide advice and highly personalized support.
  • Insightful data analytics. Our Maestro Health Analytics™ and Autotrigger™ tools provide timely, actionable data and reporting to maximize cost savings, care coordination and the overall benefits experience.
  • Modernized member engagement solutions. We offer personalized, data-driven member engagement tools, rooted in proven marketing strategies, designed to increase benefits knowledge and engage members with their health plan.
  • Mindful claims auditing. Our in-house team personally reviews high-dollar, complex claims so our clients aren’t stuck with inaccurate charges.
  • “We’ve got your back” service. We pride ourselves on delivering a high level of service to our clients. We have an NPS score of 30, near-perfect (99.95%) financial accuracy of claims payment and just one number for employers and members to call when they need help.

How do you drive member engagement in our health and wellness programs?

We approach engagement using our own “edu-marketing” style, an impactful blend of education and marketing strategies designed around delivering the right information at the right time.

How long does it take to implement a benefits plan?

Implementation can take anywhere from 60 to 90 days, depending on the options and services you choose for your plan, access to data and several other factors.

Who's your typical client?

We work with many clients across a variety of industries to administer their self-funded benefits. Our “sweet spot” is groups with 250-5,000 lives, but our solution is scalable to accommodate groups from 2 to 10,000+ lives.

Do you work with fully-insured companies?

No, we only support self-insured companies to administer their benefits.

Which of my benefit vendors does Maestro Health replace?

Maestro Health provides several services and access to key partners to make it easier for our employer clients to manage their self-funded health plans. When our services aren’t in-house, we’ll act as your point-person to help manage relationships with our preferred partners so you’re not juggling vendors.

Here’s a look at what we offer:

  • Benefits administration
  • Enrollment support
  • Consumer-directed spending accounts
  • Personalized ember engagement materials
  • Claims management
  • Repricing services
  • In-house clinical care management
  • Wellness programs

Here’s a look at the services we partner with:

  • Telehealth
  • Pharmacy benefits managers
  • Stop-loss insurance
  • Lab and diagnostics

Do you support or administer Medicare?

No, we concentrate on administering benefits for active, employer-sponsored populations.

How much does it cost to work with Maestro Health?

You’d be surprised at how cost-effective our services are. We aim to be as transparent and straightforward with our clients as possible. We deliver valued services at a fair profit and we’re upfront about what we charge. Get in touch with usto learn more about our pricing.

Can I send you an RFI?

Yes, contact us if you’d like to submit an RFI.