Client Success Story: Cardiac Arrhythmia Case

Overview:

A 64-year-old male treated at a Southeastern medical center was diagnosed with supraventricular tachycardia among other serious conditions over seven months in 2024. His extensive treatment included a prolonged stay in the critical care unit, numerous tests, and minor surgery, cumulatively billing at a substantial cost.

Diagnosis:

• Supraventricular Tachycardia (I4710): An erratic heartbeat affecting the heart's upper chambers, with rates ranging from 150 to 220 beats per minute.
• Severe Protein-Calorie Malnutrition (E43): A condition impacting recovery and treatment outcomes.
• Metabolic Encephalopathy (G9341): Affects brain function due to metabolic imbalances.
• Pneumonitis (J690): Lung inflammation from inhaling food and vomit, complicating breathing.
• Cerebral Edema (G936): Brain swelling due to excess fluid, exacerbating other medical issues.

Challenge:

The patient incurred a billed amount of $968,710.15 for comprehensive care necessary to manage his cardiac arrhythmia and accompanying conditions, presenting a financial challenge for the health plan due to the complexity and resource intensity of the treatments.

Solution:

H.H.C. Group undertook the challenge of managing and negotiating this claim. Leveraging extensive knowledge of the medical center's billing practices and previous negotiation experiences, an attorney case manager initiated detailed negotiations aimed at reducing costs significantly.

Results:

The rigorous negotiation concluded successfully within ten business days, with the medical center agreeing to H.H.C. Group's proposed amount of $461,099.28. This resulted in savings of $174,367.83 below the PPO discount amount of $635,467.11, which had already reduced the billed amount by 34.4%. The final negotiated savings amounted to 52.4% below the initial billed charges.

Financial Breakdown:

• Billed Amount: $968,710.15
• Fee Schedule Amount: $635,467.11 (34.4% below billed amount)
• HHC Negotiated Amount: $461,099.28
• Savings: $174,367.83 (27.4% below PPO discount)
• Total Savings: $507,610.87 (52.4% below billed amount)

Conclusion:

This case underscores H.H.C. Group's commitment to providing substantial financial relief and expert support to patients facing significant medical and financial challenges. Through skilled negotiation, the payment was nearly halved, showcasing H.H.C. Group's crucial role in healthcare cost containment and patient support. This success story highlights the importance of proficient negotiation skills in managing healthcare costs effectively.

For more information on how H.H.C. Group can assist in managing complex healthcare claims, contact us today.