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.
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.