Trusted Ties Lead to 60% Savings on ICU Claim

November 03, 2025 Overview

A 27-year-old male was admitted to an Eastern U.S. hospital with severe sepsis, pneumonia and acute respiratory failure. He required mechanical ventilation and spent 12 days in the intensive care unit. Even with PPO repricing in place, the cost of this in-network hospitalization remained well above a defensible level, creating significant financial exposure for the plan.

Challenge

The hospital billed $343,913. Even after PPO repricing, the allowed amount stood at $194,750, still far above a defensible payment threshold for the care rendered. The plan faced the possibility of a six-figure overpayment without further action.

Solution

H.H.C. Group's attorney negotiator had already established a trusted relationship with the hospital's Patient Account Manager. Leveraging this connection, the Case Manager engaged directly and clearly explained the basis for a lower, fairer payment. The rationale, grounded in clinical context and precedent, was well received. The Patient Account Manager agreed based on these and a signed agreement was secured the same day.

Results

• Billed Amount: $343,913
• PPO Allowed Amount: $194,750
• Negotiated Payment: $77,902
• Incremental Client Savings: $116,848
• Saved vs PPO Allowed: 60.0%

Real People. Real Savings.

This case highlights how trusted relationships, combined with clinical insight and strategic negotiation, deliver meaningful savings, even on high-cost inpatient claims. H.H.C. helped reduce liability by over $116,000 while preserving provider goodwill and speeding resolution.