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The Pleasantly Persistent Case Manager

HHC Group Success Story 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

Provider Charge: $1,370,483

PPO Discounted Charge (% Discount): NA

HHC Adjusted Charge: $852,000

% HHC Savings versus List Charge: 37.8%

Client Savings: $518,483

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