Phia Group – Claim Negotiation & Sign Off – Case Study

PHIA

“The provider, as is the case with many, initially told us that it was not interested in negotiating at all….”

From The Phia Group monthly newsletter (July 2015):

The Phia Group’s client referred two out-of-network claims, for the same patient and provider, totaling approximately $77,000. The provider was one which had historically never offered the TPA’s former negotiation vendor a reduction higher than 14%.

Once the referral was received, The Phia Group performed a preliminary review of the claims and called the provider to engage it in a dialogue. The provider, as is the case with many, initially told us that it was not interested in negotiating at all, but we obtained a fax number for the provider nonetheless. The provider was not interested in discussing the particulars over the phone.

A member of The Phia Group’s negotiation team sent a very strongly-worded correspondence that unpacked benchmarks on the claims, explained some coding considerations, and detailed legal and financial reasons why a settlement was in the provider’s best interests.

Upon receipt of this letter, the provider promptly executed the agreement to accept $17,500 as full and final payment from the health plan, resulting in savings of nearly $50,000. As with all of The Phia Group’s claim negotiations, the provider agreed not to balance-bill the patient for the remainder.

Billed:         $77,000

Paid:           $17,500

Savings:     $59,500

 

Comments are closed.