HHC Saves Client 75.3% on Outpatient Surgery Claim

January 19, 2024

A West Coast Outpatient Surgery Center recently performed an operation to reconstruct a patient's upper and lower (Maxillary and Mandibular) facial bones to correct deformities, changing the jaw position to improve the alignment of the upper and lower jaw/teeth. The Surgery Center's bill came to $202,626.00. HHC Group's client asked us to review the bill and negotiate a settlement for the appropriate amount if the charges were too high.

Approach

Our Case Manager took charge, leveraging a combination of technology, tenacity, and his extensive expertise. He began by using published and proprietary databases to determine the appropriate amount to pay for the services rendered. Armed with this information, the Case Manager engaged in discussions with the Surgery Center's billing and collection department. Through strategic negotiations with the decision maker, the Center agreed to the revised payment amount and sent a signed agreement, sealing the deal. From the initial contact to receipt of the signed agreement, the entire process took a mere two days.

Results

The outcome was nothing short of remarkable. The billed amount of $202,626.00 was skillfully negotiated to $50,000, resulting in a client savings of $152,626.00 – an impressive 75.3% reduction. This not only demonstrated the efficiency of our negotiation process but also highlighted the substantial financial relief provided to our client.

Provider Type: West Coast Out-Patient Surgery Center

Claim Type: Out-of-Network

Diagnosis: The patient was diagnosed with M26.02 Maxillary hypoplasia and M26.04 Mandibular hypoplasia, requiring upper and lower jaw reconstruction.

Billed Charge: $202,626.00

H.H.C. Group Negotiated Amount: $50,000

Client Savings: $152,626.00