$147K in Additional Savings Beyond PPO on Complex Trauma Case

When a catastrophic trauma case resulted in a 36-day hospitalization and a high six-figure claim, H.H.C. Group delivered significant additional savings beyond the PPO allowable—reducing costs by nearly 26% off the allowable while ensuring accurate, clinically appropriate reimbursement.

• Facility: Hospital in Southeastern U.S.
• Patient: 16-year-old male
• Length of Stay: 36 days
• Diagnosis: Multiple significant trauma (auto accident)
• Procedure: Craniotomy for traumatic brain injury
• DRG: 955 – Multiple Significant Trauma with Craniotomy

• Billed Charges: $705,025.81
• PPO Allowed Amount: $570,442.37
• PPO Savings: $134,583.44 (19%)
• H.H.C. Negotiated Amount: $423,015.48
• Additional Savings: $147,426.89
• % Savings vs. PPO Allowable: 25.8%

This case involved extensive injuries, including traumatic brain hemorrhage, thoracic aorta laceration, and multiple fractures—requiring high-acuity care and surgical intervention.

Despite PPO involvement, the remaining allowable exceeded $570K, leaving significant opportunity for cost reduction. Complex trauma cases under DRG 955 often include:

• High-cost surgical and ICU services
• Multiple diagnoses and intensive medication management
• Increased risk of inflated or misaligned billing

Without further intervention, the plan faced substantial overpayment exposure.

HHC Group applied a comprehensive cost-containment strategy combining financial precision with clinical insight:

• DRG Validation & Bill Review: Ensured the DRG classification and associated charges accurately reflected the level of care provided, preventing overpayment due to potential billing inflation
• Line-Item Analysis: Identified opportunities for cost reduction across high-dollar services
• Attorney-Led Negotiation: Engaged provider directly to secure a fair, defensible reimbursement aligned with the complexity of care

This hands-on approach ensured that every dollar paid was both financially reasonable and medically justified, consistent with HHC Group's dual clinical and financial review model.

HHC Group delivered $147,426.89 in additional savings beyond PPO discounts, reducing the claim by 25.8% off the allowable amount. Notably, total incremental savings exceeded the original PPO reductions, demonstrating meaningful impact even after initial repricing. The final reimbursement was aligned with both the clinical complexity of the case and fair market value—ensuring the plan paid accurately, not excessively.

HHC Group successfully reduced costs on an already-discounted claim—demonstrating that PPO pricing alone is not enough to control high-cost cases.

Even in the most complex trauma cases, deeper savings are possible with the right expertise. HHC Group goes beyond standard repricing—combining clinical insight, financial accuracy, and real negotiation power to deliver results that protect both plans and members.

Stop overpaying. Contact H.H.C. Group today to uncover additional savings on your highest-cost claims.