February Case of the Month — $123,000 Saved on a Non-Fee Schedule Workers' Comp Spine Claim

Overview

A 50-year-old female was treated at a medical center in the Eastern United States for cervical region intervertebral disc disorders with myelopathy. The patient underwent multiple cervical spine procedures, including spinal fusion, to relieve nerve compression. The claim arose under a non-fee schedule state workers' compensation program.

The provider billed $159,000 and because the claim fell in a non fee scheduled state there was no mandated reduction offering protection for the payor. Without experienced intervention, the plan faced full liability for the billed charges despite the presence of multiple procedures and add-on codes that warranted deeper review.

HHC Group's attorney-led negotiating team identified and engaged the provider's decision-maker directly. Following a detailed review of the claim, the negotiator prepared and submitted a defensible payment proposal supported by clinical context and industry standards.

During direct discussions, the negotiator addressed the appropriate application of multiple procedure discounts and reviewed the use of add-on codes on the claim. A revised proposal reflecting these considerations was submitted. The provider agreed with the rationale presented and a signed agreement accepting the reduced amount as payment in full was secured the following day.

• Billed Amount: $159,000.00
• H.H.C. Group Negotiated Payment: $36,000.00
• Total Client Savings: $123,000
• % Saved vs Billed Allowed: 77.4%

In non-fee schedule workers' compensation claims, payers are exposed to full billed charges with little built-in protection. This case demonstrates how experienced, attorney-led negotiation and a clear, defensible strategy can dramatically reduce liability.

HHC Group delivered a fair and compliant outcome, cutting the claim by more than three-quarters and securing rapid resolution without compromising provider relationships.

Don't accept full billed charges when fee schedules don't apply.

Contact HHC Group to review your non-fee schedule workers' compensation claims and uncover savings that PPO repricing alone can't deliver.