Problem: A plan member smashed his pinkie, requiring his fingernail be removed via a laser procedure. An outpatient surgery center charged a $35,500 standard rate, contract discounted to $28,000.
Solution: MedBen’s claims surveillance system flagged the claim for clinical review. After studying the claim, a medical specialist advised that $2,000 was an average industry cost for the procedure.
Outcome: MedBen contacted and worked with the surgery center, which ultimately agreed to the lower cost.
Problem: A MedBen Client wanted reduced costs without cutting plan member benefits.
Solution: Working with MedBen, the Client signed direct contracts with two hospitals in areas with a high employee presence.
Outcome: In the first year following direct contracting, the client saw an 18% reduction in their medical spending, while plan members saw lower out-of-pocket costs.
Case Study: Claims Surveillance
Problem: A plan member underwent robotic hernia repair for a ventral hernia. The Client was billed $310,000 for 15-minute usage of robotics – over 10 times the usual allowed amount.
Solution: Through our proprietary claims surveillance software, this claim was flagged and reviewed by a board-certified specialist who noted the excessive billed amount.
Outcome: The claim was negotiated and the Client saved $250,000. The provider accepted the payment with no “balance billing.”