I have worked with Mike Madden from SCM for the past year and found him to be very professional, competent, reliable, knowledgeable, and a very flexible colleague to work with. His extensive knowledge of medical underwriting and medicine is very evident in his concise and clear medical review reports plus all reports are returned within 24 -72 hours or less.
I do not hesitate to recommend him to anyone seeking his expertise in supporting an underwriting staff in reviewing employee stop loss cases.
Prodigy like most stop loss carriers has been plagued with runaway costs associated with dialysis treatment for our ESRD patients. Like many of our colleagues, we struggled to understand the cost variations among our patient population even when treatment regimens and settings were the same.
In an effort to control the dialysis exposure, we searched for cost management solutions among a variety of vendors. Once our research was done, we had identified Specialty Care Management (SCM) as a dominant provider in the area of dialysis cost management. While we understood the SCM impact, many of our clients voiced concern over the potential challenges of a Medicare style re-pricing, so we started with a couple of patients. The SCM re-pricing process virtually eliminated all challenges and when appeals were filed, SCM was quick to respond protecting both our client and their member.
The SCM team generated significant savings across our entire dialysis patient population with net savings averaging more than 60% after all fees and costs. The end result is that Prodigy has reduced our loss ratio and improved the underwriting position. I would recommend that any stop loss carrier, TPA or client consider the SCM solution for their dialysis exposures. The impact to the bottom line is worth exploring.
We have worked with Specialty Care Management for many years on behalf of our clients. They have saved our clients hundreds of thousands of dollars. Their high level of expertise and consultative services have provided us and our clients with a turnkey approach in the management of services including dialysis and cancer management. We recommend using Specialty Care Management to all our clients.
In addition we know the client will get the quick response, education and service needed and most importantly the savings. I can recall one instance where we acquired an account not because our rates were the lowest, but because the group was impressed by our introduction of SCM ,learning of their savings ability and service.I as well as our sales reps feel confident that when we recommend SCM to any current or potential client they will experience a positive experience and the positive results promised will be gained.
SCM helped me with “the obscene cost of dialysis…” and has “reduced the cost for our clients and has minimized the lasers at renewal.”
SCM is “easy to work with” and there was “no real push-back from the providers once we show them the document wording.” Clients “will appreciate the results and experience.
We have been working with SCM services since 2011. We have found SCM Services to be an added value to our stop loss product. Our needs, in particular, are to control the ESRD claimant with high cost hemodialysis. When a client is presented with a $500,000-$600,000 separate specific deductible on a hemodialysis claimant there is an advantage for all involved to be able to offer SCM’s services as an alternative in cost savings.
Specialty Care Management has been a real partner. Using Specialty Care Management services the reinsurance carrier reduced the lasers on those employees to an affordable rate. SCM was able to re-price the claims to an amount that would allow the County to keep their employee health plan. The re-priced amount kept the employees with the end stage renal diagnosis from escalating their laser amount when the plan year ended.
Specialty Care Management sends the claims in a timely manner to be processed and paid. We have had several appeals sent to us by the renal dialysis provider and Specialty Care Management has handled those appeals each time in a professional manner. With the response to the appeals given to us by SCM the County has been able to dodge being balanced billed by the renal dialysis provider. Our mutual client has used SCM’s services now for three years and are completely satisfied with services rendered by SCM.
Our third party administration firm serves a diverse population with a portion of that population predisposed to certain disease states which lead to renal failure and subsequent dialysis services. Due to the very high cost associated with dialysis our company was seeking a solution for those rapidly rising costs.
In 2011 we performed a due diligence based search for a service partner who could offer a program which would be both cost effective and defensible. At the end of the search we determined SCM to be that solution. SCM’s program incorporates the use of multiple cost containment and relational strategies effectively integrated to create the best result. SCM has met the needs we had and has fulfilled the commitments and promises made in regard to their product, client service, follow up and results.
We had a client that was a small County Government and they had two employees diagnosed with End Stage Renal Disease. This diagnosis would require the employees to seek renal dialysis as a treatment. When the reinsurance carrier for the County’s health plan saw that diagnosis and treatment plan they were going to impose two $500,000 lasers on those employees. These lasers would have financially crippled the County and forced them to drop the employee health plan. Luckily the reinsurance carrier introduced us to Specialty Care Management.
I would say that it has been a total “win win: for our client utilizing Specialty Care Management services. At the time we were introduced to Specialty Care Management we were at a loss as to how to help the County with their situation with those employees with the ESRD diagnosis and their health plan. SCM offered an affordable easy solution that made it possible for our client to continue to offer health care to their employees.