Expert Negotiation on J-Code Claims Saves tens of thousands

A patient incurred 10 in-network claims covering Factor VIII monthly infusions for the treatment of Hemophilia A over a 10-month period, resulting in a total billed amount of $1,954,817.70. The PPO allowed amount was $754,847.47 (61.4% discount). But, the already expensive J-code (infused drugs), administered by the provider and upcharged, were included in the cost of the claim.

That's when the third-party administrator (TPA) contacted H.H.C. Group to help reduce the amount of the bill even further by negotiating the J-code charges.

H.H.C. Group's team of expert case managers and attorneys was able to save the group even more money on these already heavily discounted claims by negotiating using reliable data and proven techniques—all within 3 to 5 business days.
We were able to negotiate the original bill from $754,847.47 to $684,186.18, successfully generating an additional $70,661.29 in savings below the PPO discounted amount.

Claim Type: In-Network

Treatment: A patient incurred 10 in-network claims covering Factor VIII monthly infusions for the treatment of Hemophilia A over a 10-month period.

Bill Charged: $1,954,817.70

PPO Discounted Amount: $754,847.47 (61.4% discount)

H.H.C. Group Negotiated Amount: $684,186.18

Client Savings: $70,661.29