Case Study
Stoploss Renal Dialysis
Laser-Focused on Renal Savings
SITUATION:
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.
CLIENT RESULTS:
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.
SCM SOLUTION:
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.
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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
Fixed, All-inclusive Capitated Rate that protects you from inflation while saving you more off provider billed charges
100% Success Rate on challenges and appeals
