An employee of a manufacturing company was receiving weekly dialysis treatments and the associated claims exceeded the specific deductible set for the employer group. Given the high cost of the claims, our CSI team was advised of the situation to determine if better pricing was available.
As Medicare is the primary payer for approximately 75% of all dialysis patients, providers typically charge very high rates to commercial health plan providers to compensate for lower Medicare reimbursement rates. This, coupled with the consolidation of dialysis providers, has created a cost environment that is exceptionally challenging for group health plans. Our CSI expert worked with the employer, their third-party administrator and a dialysis cost containment provider to remedy the inflated charges while ensuring no disruption to the employee’s treatments.
With an updated plan document that now includes a dialysis repricing solution, the employer was able to save $360,000 annually.