Trigger Code Claim Win in Just 5 Days: Saved Incremental 66% on High Dollar Prostate Cancer Surgery

September 02, 2025 Overview
A high-dollar, cancer-related claim flagged early using a "trigger code" led to rapid, deep savings for a large Midwestern TPA. The term "trigger code" means the claim was flagged early for potential high cost. Without fast action, the claim could have slipped through under "standard processing" — pushing unnecessary costs onto the plan and possibly activating stop-loss.

This claim involved multiple cancer-related procedures performed at a Southern U.S. medical center, a facility H.H.C. Group had successfully negotiated with previously and maintained a relationship with the hospital's financial executive team. Though the claim was in-network and subject to PPO pricing, the initial liability still threatened to push the TPA into stop-loss territory.

Challenge
The provider billed $120,027 for laparoscopic radical prostatectomy and lymphadenectomy related to malignant neoplasm of the prostate, a critical cancer staging and treatment procedure. Even after PPO discounts, the allowed amount remained $88,268, far too high for the TPA to absorb without risk.

Solution
H.H.C. Group's attorney-led negotiator quickly leveraged an existing relationship with the hospital's financial decision maker, saving crucial time and raising the odds of success. Backed by internal benchmark data and 30+ years of complex claim negotiation expertise, the team:

• Used clinical context and historical precedent to propose a fair, defensible payment.
• Highlighted the inefficiency of relying on PPO discounts alone for high-cost, in-network cancer procedures.
• Closed the deal within 5 business days, start to signed agreement.

The Results

• Billed Charges: $120,027
• PPO Allowed Amount: $88,268
• HHC Negotiated Payment: $30,000
• Incremental Client Savings: $58,268
• % Saved vs PPO Allowed: 66.0%
• Turnaround Time: 5 business days

Real People. Real Savings.

Trigger codes aren't just red flags, they're opportunities. In this case, H.H.C. Group helped the TPA avoid a catastrophic overpayment by acting fast, leveraging negotiation experience and moving beyond standard PPO discounts.

Even on in-network claims, significant savings are possible, with the right partner and the right relationships. H.H.C. Group goes beyond standard reviews, stepping in quickly, strategically and effectively to secure real results — every time.