A 42-year old patient received dialysis in Louisiana from one of the two largest companies that provide dialysis services. Monthly charges were running $46,371. 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.
With Specialty Care Management engaged, a revised quote with use of the SCM products was issued; the new laser level was set at $130,000 for dialysis and other medical treatments, and $120,000 for the transplant. The implementation of the renal and transplant products reduced the laser by $475,000, on a claimant that had incurred over $500,000 of claims year-to-date at renewal on May 1.
The recommended repricing on $556,454 in billed charges resulted in direct savings of $498,369 or 89.56% for the on claims incurred during the following plan year 5/1 – 4/30.The comprehensive savings, inclusive of impact on carrier pricing, to the plan for the plan year totaled $973,369.