Client Success Story: Laparoscopic Out-of-Network Surgery Case

April 03, 2025

Overview:

A 30-year-old female patient faced significant health challenges, including a double uterus, abnormal uterine and vaginal bleeding and noninflammatory disorders of the fallopian tube and broad ligament. She underwent a laparoscopic procedure at an Endoscopy & Family Center on the West Coast, billed as an out-of-network case with a substantial initial charge.

Challenge:

The patient's complex condition necessitated specialized laparoscopic surgery to diagnose and treat ureteral, intestinal and bladder bleeding, as well as atypical tissue growth. The initial billed amount for this out-of-network procedure was $343,638.80, posing a significant financial burden.

Solution:

H.H.C. Group took charge of the situation by deploying an attorney case manager with deep expertise in laparoscopic procedure claims. Utilizing public and proprietary HHC Group databases, the case manager reviewed the claim thoroughly to establish a fair cost based on the services provided. After identifying the provider's decision-maker, a reasoned offer was made, supported by robust data and benchmarks.

Results:

The negotiation was swift and effective, concluding with a signed agreement within just three working days. The provider accepted the negotiated amount of $68,000 as full payment, resulting in savings of $275,638.80, which represents an 80.2% reduction from the initial billed amount.

Financial Breakdown:

• Billed Amount: $343,638.80 (Initial charges for the laparoscopic surgery.)
• Negotiated Amount: $68,000 (Amount agreed upon after negotiations.)
• Savings: $275,638.80 (Represents an 80.2% reduction from the original billed amount.)

Conclusion:

This case exemplifies H.H.C. Group's proficiency in handling complex medical claims and negotiating substantial cost reductions. Through expert analysis, strategic negotiation and a focused approach, H.H.C. Group not only achieved remarkable financial savings but also ensured that the patient received necessary medical care without the added stress of overwhelming medical costs. This success story highlights H.H.C. Group's commitment to providing tailored, cost-effective solutions for out-of-network medical claims.