Cutting Through the Noise to Deliver 65% Savings

An Unwrapped client of Phia’s had a patient whose parents wanted him to see an out-of-network vendor to continue care for autism. Even though there were several facilities in the area covered by the client’s in-network solution, the parents were adamant about treatment at this facility. So much so that they were threatening to report our client to the DOI, all while seeking legal counsel.

 

Phia received the SCA that had been proposed by this facility for payment. The billing amount that was on the SCA for a few service codes was just over $14k a WEEK! At 60% of billed charges, which was the offer from the facility, our client was staring down payments of over $8k weekly.

 

After conducting an extensive review of the facility’s proposal, along with aligning the client’s goals and expectations, Phia decided that this was a task that could be handled. The first line of business was to have the facility review its offer and submit another proposal before Phia began discussing numbers. A negotiation letter was sent to this facility requesting a review of their submission with the mention of Medicaid rates.

 

Although it can be difficult for providers to agree to any sort of agreement based on Medicaid rates, the original document provided to the facility was just enough for the provider to come back to Phia and advise that they would accept the state’s Medicaid Fee Schedule. The client was extremely pleased with this result, not only in the monetary terms, but the quickness with which Phia got this across the finish line.

 

By partnering with The Phia Group, our client was able to have the facility sign an SCA resulting in additional savings of nearly 65% from the original proposal ($4,500 a week), which prevented the member’s parents from reporting to the DOI. The patient now has treatment at the facility of their choosing for the duration that services are needed.