Year-End Win: 47.8% Saved Beyond PPO Discount on a High-Cost Spine Claim

December 30, 2025 Overview
A 54-year-old female was admitted to a hospital in the Southeastern United States for a planned multilevel anterior and posterior spinal fusion to treat intervertebral disc disorders with radiculopathy. She remained inpatient for two days. Although the procedure was performed in-network and subject to PPO pricing, the claim still posed significant financial exposure for the plan.

The Challenge
The hospital billed $637,245. PPO repricing reduced the allowed amount to $287,392, reflecting a 45.1% discount. Following review, H.H.C. Group determined that the remaining liability exceeded a fair and appropriate payment level based on clinical context and industry benchmarks. With the claim received on December 16, the plan faced a substantial year-end expense with limited time to act.

The H.H.C. Group Approach
An H.H.C. Group attorney-led negotiator—also a licensed health insurance adjuster—performed a detailed claim review using clinical context, historical precedent and H.H.C.'s proprietary benchmarking data. The negotiator identified the appropriate provider decision-maker and presented a clear, defensible payment rationale aligned with industry standards. Through direct engagement, the provider agreed to the proposed amount, and a signed agreement accepting the reduced payment as payment in full was secured within two days saving the plan an incremental $137,392.

Results

• Billed Amount: $637,245
• PPO Allowed Amount: $287,392
• HHC Negotiated Payment: $150,000
• Total Group Savings: $137,392
• % Saved vs PPO Allowed: 47.8%

Real People. Real Savings.
Even after significant PPO discounts, this case illustrates how expert review and skilled negotiation can deliver substantial additional savings. By reducing liability by nearly half beyond the PPO allowed amount, H.H.C. Group helped protect plan assets and deliver a fair, defensible outcome at a critical point in the year.

Plans that rely solely on AI generated acceptance of PPO repricing are often overpaying. H.H.C. Group brings the experience, credibility and human expertise needed to determine appropriate payment levels and secure results that stand up to scrutiny.

Start the year with stronger claim controls. Contact HHC Group to evaluate high-cost claims, uncover additional savings beyond PPO discounts and ensure every payment is fair, compliant and defensible.