July Case of the Month: H.H.C. Group Secures Additional 37.8% Savings Beyond PPO Discount Through Strategic Provider Negotiation

When a 55-year-old patient required a complex 15-day hospitalization that included an ICU stay, H.H.C. Group identified additional savings opportunities beyond an existing PPO discount. Through strategic outreach and experienced negotiation, the team secured an additional $34,304 in savings, reducing the final reimbursement by 37.8% beyond the PPO allowed amount.

• Emergency department admission
• 1 day in the intensive care unit (ICU)
• 14-day inpatient stay in a private room

• Acute and chronic respiratory failure with hypoxia

• Acute infarction of the intestine
• Chronic systolic congestive heart failure
• Chronic obstructive pulmonary disease (COPD) with acute exacerbation
• Acute kidney injury

Extended hospitalizations involving critical care and multiple serious diagnoses often generate significant reimbursement obligations for self-funded health plans. Although this claim had already received a 51.8% PPO discount, additional savings opportunities remained.

Just as importantly, successful negotiations often depend on identifying the individual who can move the process forward—not simply the first point of contact.

H.H.C. Group conducted a comprehensive reimbursement review and initiated direct negotiations with the provider. During the process, the negotiator recognized that the CFO's executive assistant—not the initial contact—was instrumental in facilitating discussions with the organization's chief financial officer.

By working with the appropriate decision-makers and leveraging decades of provider relationships and attorney-led negotiation expertise, H.H.C. Group secured agreement on a reduced reimbursement and successfully finalized the negotiated settlement.

• Billed Amount: $188,459.50
• PPO Allowed Amount: $90,842.00
• H.H.C. Group Negotiated Payment (Final Resolution): $58,537.85
• Additional Savings Beyond PPO Discount: $34,304.15
• Additional Reduction from PPO Allowed Amount: 37.8%

Every claim tells a different story, and successful negotiations often require more than data alone. H.H.C. Group combines experienced negotiators, provider relationships and strategic outreach to identify opportunities others may miss—helping self-funded employers, TPAs and stop-loss carriers achieve meaningful savings beyond traditional PPO discounts.

Ready to uncover additional savings opportunities within your claims inventory? Contact H.H.C. Group to learn how our cost-containment solutions help maximize savings while ensuring fair, defensible reimbursements.