Imagine a health plan that requires you to pre-authorize non-emergency claims such as a colonoscopy. Imagine area providers bidding on your medical care. If you can get the colonoscopy for $1,000 instead of $3,000, which one would you choose?
We have found several companies that will negotiate claims for self funded health plans on this basis. This is information on one of those companies – www.primarypc.com
Primary PhysicianCare, Inc. contracts with a client to perform case rate negotiation services for all scheduled surgeries, hospitalizations and diagnostic tests. As each medical encounter was pre-certified through the medical department, it was screened for potential case rate negotiation. The following steps were completed for each case under review:
- Determine network status of provider
- Determine current contract discount level
- Analyze alternative treatments
- Analyze for alternative facilities/locations
- Engage provider in price negotiation
- Document negotiated price and pended claims
Healthgram® software aids in the process of negotiating charges with a medical provider or facility. All specific encounters are negotiated before payment is made. Review of the itemized bill, disclosure of the provider’s purchase order of supplies, etc. are reviewed as part of the negotiation process. Once full transparency is achieved, a substantial discount is typically obtained.
Here are the top 5 cases that were negotiated during this study period:
| Billed Charge |
Negotiated Amount |
% | Client Saved |
Notes |
| $33,355 | $9,179 | 72.5% | $24,175 | 1 day inpatient hospital stay for uterine procedure for non-malignancy |
| $78,829 | $51,238.94 | 35% | $27,590 | 8 day inpatient stay for motor vehicle accident resulting in multiple fractures |
| $45,725 | $23,000 | 49.7% | $22,725 | OutpatientHospitalprocedure for a broken collar bone |
| $19,744 | $9,875 | 50% | $9,869 | 1 day hospital stay for a broken leg |
| $154,689 | $108,282 | 30% | $46,406 | Outpatient hospital procedure for a highly complex knee injury |
