Experience and Technology - A Winning Combination

A plastic surgery group submitted this claim for a surgical assistant who participated in double reconstructive breast procedure Using his years of experience and HHC's databases, the Case Manager (CM) determined the appropriate amount paid surgical assistants in relative to primary and
secondary surgeons.

In this case, that amount was $18,800. The CM explained to the provider why this amount was appropriate. The provider agreed, signed HHC's proposal and the TPA paid the claim on behalf of the group.

Claim Type: Hospital In-Patient

Provider Type: Surgical Assistant

Location: Northeast

Diagnosis: Breast Cancer

Treatment: Reconstructive Surgery

Provider Charge(or Facility Charge): $168,800

PPO Discounted Charge/Fee Schedule: NA

HHC Adjusted Charge: $18,000

% Added Savings from List Charge: 89.3%

Client Savings: $150,800