How to save 10,000 $ On a Gallbladder Surgery and get an outstanding patient outcome: 
Case Study

Challenge 

 

Find a quality provider who offers a fair price, a facility that will not balance bill member

 

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Plan Background

 

RBP Plan Design

Member lives NE of Wash. DC

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Options

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For the local hospital provider, the plan shopped the procedure with hospitals and providers in local area.  Best price was $18,000 which included facility fees, surgeon and anesthesiologist.  Patient would have been balance billed for any reimbursement lower than this. 

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For the direct contract provider, Local ASC utilizing top-rated surgeon in the region performed procedure for $7300, all inclusive.  After consult, surgery scheduled and completed before hospital could schedule.    

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BENEFITS

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1. Care Navigator walked with Patient

      through the process

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2. Patient had no out-of-pocket expense

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3. Patient had no worry about balance bill

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4. Plan knew cost and had no additional cost

      for negotiating the claim

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IMPACT

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1.Patient fully recovered

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2.Plan saved over $10,000

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3.Provider paid quickly without

      threat of claim audit