Health Insurance Industry Issues and Legislation
A 58-year-old patient required a 23-day hospitalization for severe sepsis with septic shock and multiple complications. Although the claim had already received a substantial PPO discount, H.H.C. Group identified an opportunity for additional savings.
H.H.C. Group's attorney-led negotiating team knew that reaching the right provider decision-maker—and allowing time for the hospital's internal review—would be critical. After identifying and engaging the hospital's chief financial officer, the team maintained persistent communication with the provider while keeping the client informed and obtaining approval to extend negotiations rather than settle prematurely.
On the 20th day, the provider executed the agreement. The result: $261,105.95 in additional savings beyond the PPO discount, reducing the PPO allowed amount by another 53.1%.
- Billed Amount: $767,958.68
- PPO Allowed Amount: $491,493.55
- H.H.C. Group Negotiated Payment: $230,387.60
- Additional Savings Beyond PPO Discount: $261,105.95
- Additional Reduction from PPO Allowed Amount: 53.1%
Successful negotiation requires experience, persistence and an understanding that every provider operates differently. H.H.C. Group's professionals know when to keep the conversation moving, when additional time may lead to a stronger result and how to keep clients involved throughout the process.
Contact H.H.C. Group to discover how expert-led claim negotiation can uncover savings that traditional discounts and standard repricing may leave behind.
Bruce D. Roffé, P.D., M.S., H.I.A., president and CEO of H.H.C. Group, explains in his latest Forbes Business Council article why repricing alone does not guarantee an appropriate final payment. Discover how claim-level review, clinical expertise, payment benchmarking and provider negotiation help payors move beyond surface-level discounts to prevent unnecessary medical spending.
Read the full article and contact H.H.C. Group to strengthen your cost-containment strategy.
At NextGen ASCEND, Amanda Evy, business development manager at H.H.C. Group, heard a clear message from modern brokers: employers need more than standard discounts and after-the-fact explanations. Discover why brokers are prioritizing stronger claim oversight, reference-based pricing, provider negotiation and clinical review—and how H.H.C. Group helps turn those strategies into practical, defensible results.
Read Amanda's key takeaways and discover how H.H.C. Group can help you deliver measurable savings, strengthen client relationships and bring a more proactive cost-containment strategy to the table.
After experiencing double-digit increases in healthcare spending, many small and midsize employers are reassessing their benefits strategies and exploring alternative funding models to better control costs. As financial pressures mount, organizations are increasingly seeking cost-containment solutions that reduce risk without compromising employee benefits.
For brokers and TPAs, this shift creates an opportunity to bring more proactive solutions to the table. H.H.C. Group provides specialized claim negotiation, medical bill review, reference-based pricing and independent review capabilities that help self-funded clients move beyond simply managing rising costs to actively containing them.
Contact H.H.C. Group to learn how we can support your clients' cost-containment strategy.
Price transparency rules have made more healthcare pricing data available, but employers still struggle to turn that information into meaningful purchasing decisions. True value requires information that helps purchasers evaluate whether costs appropriately reflect the care and services being provided.
H.H.C. Group helps payors and self-funded employers translate complex claims information into actionable cost-containment strategies through expert review, repricing and negotiation.
Contact H.H.C. Group to learn how a more informed approach can help reduce unnecessary healthcare spend.
