New User? Register now

Success Stories

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.

Claim Type: In-Network

Provider Type: Children's Hospital

Location: Midwestern United States

Treatment: The baby was placed on a ventilator for more than 96 hours. An endotracheal airway was inserted into her Trachea. She received continuous nebulizer therapy as well as transfusions of non-autologous red blood cells via a peripheral vein using a percutaneous approach.

Provider Charges: $478,602.08

Discrepant Charges: $170,809.08 - The hospital billed for room and board and separately for ventilator management, daily oxygen reading and exhaled CO2 monitoring which are customarily included in the room and board charge. Additionally, they billed for routine nursing care as well as for individual breathing treatments and continuous nebulizing which are normally included in routine nursing care.

Corrected Charges: $307,809.08
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.

Claim Type: Out-of-Network

Provider Type: Hospital

Location: Midwest

Diagnosis: Patient was admitted for congestive heart failure (CHF), respiratory and kidney failure, gastritis with bleeding, A-fib, and malnutrition

Treatment: Help!

Provider Charge: $1,370,483

PPO Discounted Charge (% Discount): NA

HHC Adjusted Charge: $852,000

HHC Negotiated Savings: $518,483

% HHC Savings versus List Charge: 37.8%
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.

Claim Type: Out-of-Network

Provider Type: Hospital

Location: Southwest

Diagnosis: Patient was admitted with diverticulosis of the small intestine,esophageal reflux, a diaphragmatic hernia and peritoneal adhesions

Treatment: Local excision of lesion or tissue of the small bowel, revision gastric anastomosis, a partial gastrectomy with anastomosis to esophagus, a laparoscopic lysis peritoneal adhesions, a laparoscopic liver biopsy and a small bowl endoscopy

Provider Charge: $381,943

HHC Negotiated Charge: $125,000

HHC Negotiated Savings: $256,943

% HHC Savings versus List Charge: 67.3%
Experience and Technology - A Winning Combination
A plastic surgery group submitted this claim for a surgical assistant who participated in double econstructive 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.

Claim Type: Hospital In-Patient

Provider Type: Surgical Assistant

Location: Northeast

Diagnosis: Breast Cancer

Treatment: Reconstructive Surgery

Provider Charge(or Facility Charge): $168,800

PPO Discounted Charge/Fee Schedule: NA

HHC Adjusted Charge: $18,000

HHC Incremental Savings: $150,800

% Added Savings from List Charge: 89.3%