December 27, 2016

General Medical Cost Management Case Studies


Plan Administrator directed RBP preserved $349,000 in plan assets (90% “savings”)
Over half way through the year a client approached us about unmanageable costs on a dialysis case.  The provider refused to negotiate and the plan wanted to pursue Reference Based Payments.  The case was referred to our strategic partners who were able to leverage the existing plan document to preserve 90% of what was billed.

Hospital Negotiation nets 50% savings to plan ($510,000+ preserved)
Working through the plan’s MGU a million dollar plus hospital claim was sent to GTSN for our partners program.  With provider sign-off the group was able to save a full 50% on this one medical incident claim.

Plan Administrator directed RBP preserved $254,000 in plan assets (71% “savings”)
Frustrated with the provider’s unwillingness to work with anyone on a more manageable payment structure for dialysis the Plan Administrator directed referral to our strategic partners who, using their existing plan language, helped the plan pay a lesser amount as directed preserving 77% of what was billed.

Click here to download a Referral Form to submit your case.