Expert Negotiation on J-Code Claims Saves Tens of Thousands
When a third-party administrator (TPA) sought to minimize medical expenses by negotiating J-code charges, they turned to H.H.C. Group for assistance. With a dedicated team of expert case managers and attorneys, H.H.C. Group employed reliable data and proven techniques to further reduce the already discounted claims within a swift 3 to 5 business days. The result was a successful negotiation that lowered the original bill from $754,847.47 to $684,186.18, generating an impressive additional savings of $70,661.29 below the PPO discounted amount.
Team Effort Saves Incremental $1.3 Million on In-Network Claim
Often, H.H.C. Group's clients request our assistance in negotiating agreements for amounts lower than the PPO discounted rates on their high-dollar in-network claims. While negotiating these claims successfully can be challenging, the resulting savings are often substantial, sometimes even very substantial. In a recent instance, the hospital bill amounted to over $2.3 million, the PPO discount was 20%. Working with our Medical Director and clinical team, HHC's attorney negotiator determined the appropriate amount for the services provided. He then contacted the hospital and got them to agree to accept $531 thousand as payment in full, saving the group and stop-loss carrier an additional $1.3 million.
The Power of Relationships
HHC Group finds and builds trusted relationships with key provider decision-makers. These relationships enable our Case Managers to secure agreements that generate sizable incremental savings for our clients even on in-network claims with deep PPO discounts, even on a rush basis. In this case, in 1 day the provider decision-maker agreed to reduce their discounted bill by 34.8% more saving the group an incremental $222,891.90.
The Case of the Emergency Room NSA Claim
HHC clients turn to us to avoid the laborious, time-consuming, uncertain, potentially costly, Independent Dispute Resolution process for claims covered under the No Surprises Act. Upon receipt of this out of network emergency room claim our client sent us the claim and asked us to work to achieve a settlement with the provider. Within 3 days the Case Manager determined the appropriate amount to pay, found and negotiated with the provider decision maker, and secured a 52.2% reduction in the bill.
No Surprise Act Air Ambulance Case
H.H.C. Case Managers are successfully negotiating settlements on air ambulance, emergency room and other out-of- network claims covered under the No Surprises Act. In this instance the air ambulance provider agreed to accept a payment amount below the Qualified Payment Amount (QPA) for their services. H.H.C.'s client saved our $39,999 (45.7%) while avoiding the time consuming and potentially costly Independent Dispute Resolution process entirely.
Saved a Bundle with Bill Reviews
A five and a half month old baby girl suffering from acute respiratory failure with hypoxia, pneumonia due to Hemophilus influenza and hypotension was first treated in the emergency room and then admitted. She remained hospitalized for 21 days. HHC Group performed a free prescreen to determine if the potential savings justified a full Line Item Bill Review. They were and HHC conducted a full review.
The Pleasantly Persistent Case Manager
Timely communications with our clients and persistence with providers are two of the hallmarks of HHC claims negotiation. In this case, our Case Manager worked her way to the decision-maker in the executive office of the provider, communicated the progress being made to the client and got an extension past the normal 5 day window for negotiating claims.
The result - A signed agreement that saved the group $518,483.
The Power of Knowledge and Relationship Building
HHC's Case Managers (CM) use a combination of published and proprietary databases built over the 20 years HHC has been negotiating claims. They also use information from our prior negotiations with the provider.
Employing these tools and the relationship HHC had previously established with the provider, the CM secured a signed agreement from the provider for a 67.3% reduction in the bill.
Experience and Technology - A Winning Combination
A plastic surgery group submitted this claim for a surgical assistant who participated in double reconstructive breast procedure Using his years of experience and HHC's databases, the Case Manager (CM) determined the appropriate amount paid surgical assistants in relative to primary and secondary surgeons.
In this case, that amount was $18,800. The CM explained to the provider why this amount was appropriate. The provider agreed, signed HHC's proposal and the TPA paid the claim on behalf of the group.