June Case of the Month: H.H.C. Group Generates Additional 29.6% Savings Beyond PPO Discount on Complex Inpatient Claim

Overview

H.H.C Group negotiates and reprices in- and out-of-network healthcare claims for self-funded plans—helping payors reduce costs and ensure fair, defensible payments.

When a 17-year-old patient required a 15-day inpatient hospitalization at a major academic medical center, H.H.C Group identified significant savings opportunities beyond an existing PPO discount. Through expert negotiation, the team secured an additional $25,598 in savings beyond the PPO discount, reducing the final reimbursement to 50% below billed charges.

Facility: University Medical Center
Location: South Central U.S.
Patient: 17-year-old female
Length of Stay: 15 days

• Pyonephrosis
• Constipation
• Gallstones
• Ovarian cyst
• Hypokalemia

• Bilateral ureter dilation and related inpatient procedures

Complex inpatient admissions involving multiple diagnoses and extended lengths of stay can generate substantial charges for self-funded health plans. In this case, the hospitalization resulted in more than $121,000 in billed charges, creating significant financial exposure for the self-funded health plan.

H.H.C Group conducted a comprehensive financial review and then negotiated directly with the provider decision maker to secure a fair and reasonable reimbursement. Leveraging decades of provider relationships and proven attorney-led negotiation expertise, the team achieved meaningful savings while helping ensure an equitable resolution for all parties.

• Billed Amount: $121,827.87
• Original Plan Payment (PPO Allowed Amount): $86,512.22
• H.H.C. Group Negotiated Payment (Final Resolution): $60,913.93
• Additional Savings Beyond PPO Discount: $25,598.29
• Additional Reduction from PPO Allowed Amount: 29.59%

For 30 years, H.H.C. Group has helped self-funded employers, TPAs, stop-loss carriers and health plans contain healthcare costs through attorney-led negotiations, medical bill review, repricing and independent clinical expertise. Whether claims are in-network or out-of-network, our team works to identify savings opportunities and deliver measurable financial results.

Even after PPO discounts are applied, H.H.C. Group continues to uncover meaningful savings opportunities that many plans leave on the table.

Ready to reduce healthcare costs without compromising quality or member protections? Contact H.H.C Group today to learn how our proven cost-containment solutions can help your organization achieve greater savings and stronger financial outcomes.