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 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

 

Plan Background

 

RBP Plan Design

Member lives NE of Wash. DC

Options

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. 

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.    

BENEFITS

1. Care Navigator walked with Patient

      through the process

2. Patient had no out-of-pocket expense

3. Patient had no worry about balance bill

4. Plan knew cost and had no additional cost

      for negotiating the claim

IMPACT

1.Patient fully recovered

2.Plan saved over $10,000

3.Provider paid quickly without

      threat of claim audit

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