“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
