Phia received a $167,000 claim from a Surgery Center (Spinal Decompression) where a client tried to negotiate it on their own and were unsuccessful. Phia reviewed the claim and engaged the provider for a settlement. After many exchanges the provider offered to settle at a case rate of 40K (still too high) but when Phia called Provider to discuss they had transferred the claim to an external accounts receivable company. This company now advised that they would only offer a 30% discount. Armed with Phia’s industry leading cost-containment Plan Language, the Plan issued a UCR payment to Provider of 10K. As expected the provider balanced billed the member until Phia’s legal team got involved – the claim was settled a week later for a total of 15K
