Stoploss Renal Dialysis
Laser-Focused on Renal Savings
A group came to Specialty Care Management (SCM) with a 42-year old patient in Louisiana that was receiving dialysis from one of the two largest companies that provide dialysis services. With yearly charges running upwards of half a million, the claim costs potentially threatened the group’s overall profit margins. The group’s original stop-loss quote included a $575,000 laser to cover the dialysis cost and a conditional $150,000 laser in place for transplant. At renewal, the patient had already incurred over $550,000 in claims year-to-date.
The group was able to leverage both SCM’s renal and transplant products to reduce the overall laser by $475,000 while SCM’s repricing of the billed charges resulted in a direct savings of nearly $500,00 or 90% for the claims incurred during the following plan year— for overall savings to the group that approached nearly $1 million.
Specialty Care Management worked with the group, utilizing SCM’s unique approach to ultimately revise and reduce their previous quote, setting the new laser level at $130,000 for dialysis and other medical treatments and $120,000 for the transplant. SCM also worked to reprice the billed charges to make costs more manageable for the group.
Are there millions in extra savings hidden in your health plan?
About Specialty CM:
We’ve designed a new way to manage catastrophic claims—one that brings costs back under control and delivers a complete risk solution. Plus, with double the savings compared to typical network discounts, we deliver maximized savings every time.
Exclusive Program Features:
No Set-Up Fee or Cost Until Utilization so you don’t pay until you have a claim
Medical Expense Protection safeguards you from extraneous medical expenses or legal fees
Flat Case Rate that protects you from inflation while saving you more off provider billed charges
Renal Claims Defense provides access to legal counsel and support for provider appeals while accepting fiduciary risk to eliminate exposure
100% Success Rate on challenges and appeals