This simple change saved the healthcare plan $31k and gave the employee a child delivery at no cost.
Case Study: Kalos Services Inc.Industry: Commercial Construction, HVACEmployee Count: 201-500
A Kalos employee visited their hospital of choice for prenatal care and to eventually schedule delivery. The employee provided their insurance ID card at the time of service. Upon scheduling the delivery, the provider called the insurance to pre-authorize the service.
The Negotiation Processbetween the hospital and insurance:
The Hospital provided an estimate of $37,594. As a Reference, Medicare would pay $6,703 for the same billed CPT Codes.
The reimbursement rate was deemed excessive so the Healthcare plan began negotiations with the Hospital. As the Hospital was sticking firm, the Administrator contacted the employee and asked that, on their next visit, to inquire about a cash payment price and relay that price back.
About Ethos Benefits
'Ethos' is the guiding principle or character /spirit of a person or organization. It's the 'why' that fuels your decision-making. Our Ethos is transparency. We believe in the truth-in the data. How does this translate to our consulting? We are real. We show you exactly how the healthcare system works and how to finally put you in the driver's seat of your healthcare spend.
About Ethos Benefits
'Ethos' is the guiding principle or character /spirit of a person or organization. It's the 'why' that fuels your decision-making. Our Ethos is transparency. We believe in the truth-in the data. How does this translate to our consulting? We are real. We show you exactly how the healthcare system works and how to finally put you in the driver's seat of your healthcare spend.
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