Case Study

Taft-Hartley Dialysis

Total provided billed charges: $4,451,519.20
PLAN SAVINGS OF 83%

Specialty Care Management (SCM) Takes Taft Hartley Savings to New Heights

SITUATION:
A Taft Hartley Fund sought help from SCM for management of its dialysis claims. Although the fund was utilizing a 20% PPO discount on its claims, it was still incurring significant dialysis costs from managing up to five patients monthly. As a first step, the SCM legal team, at no additional cost to the fund, reviewed the fund’s Summary Plan Description and identified specific plan language to revise as part of a plan amendment. After approval, SCM collaborated with the fund to implement the amendment, working with the patients to maintain quality dialysis care. Members were able to remain at their existing dialysis facilities with no additional out-of-pocket costs.
CLIENT RESULTS:

Specialty CM was able to save the fund over $3.7 million off provider billed charges without members experiencing any disruption in quality of care.

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