 | ||
 |
HCC Life Insurance Company's new Preliminary Claim Unit (PCU) works diligently to save our mutual clients money. Below are two success stories in which the PCU department recognized savings through the use of HCC Life's preferred vendors. Prophylactic Mastectomy Group Deductible : $200,000 Claimant elected to have a mastectomy due to cancer gene markers and a family history of cancer. She traveled from Indiana to a hospital in Louisiana for the procedure. Hospital charges were $124,250.67 in addition to the charges for two surgeons at $67,000 each. The claims and medical records were sent to a vendor for review of questionable charges. It was determined that the hospital did not meet the underlying plan's definition of "Hospital" as they are neither accredited by the Joint Commission on Accreditation of Healthcare Organizations nor the American Osteopathic Association - generating an immediate savings of $124,250.67. Negotiations with the two surgeons resulted in an additional $83,026 discount. Combined efforts generated a total savings of $207,276.67. |
|
 |
Cardiac Device Implantation Group Deductible: $150,000 A 56-year-old gentleman sustained a heart attack and within days was implanted with a pacemaker. HCC Life's claims department requested the Preliminary Claim Unit review the excessive charges so the claim and clinical notes were sent to a vendor for review. The claimant's medical records were reviewed and it was determined that the device was not implanted according to standard medical guidelines. With agreement from the employer group, the cost of the device was denied resulting in an $82,332.43 savings. |
|
 | ||
