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The right care at the right price

An advisor's proactive approach led to a location shift worth over $20,000 in plan savings and reduced out-of-pocket costs for a member.

"I had no idea that I could have the same surgery, done by the same doctor at a different location, and save thousands." - Brian, Healthgram member

The Outcome

  • Advisor was alerted that a member was pre-certified for ACL surgery.
  • The plan saved over $20,000, and the member saved on out-of-pocket costs.
  • After hearing about Brian's experience, a coworker called her Advisor before scheduling a hip replacement.

The Challenge

Studies have shown that the availability of price transparency tools alone don’t impact savings. And most members don’t know that they’re headed to high-cost providers or that they’re overdue for preventive care. But with an Advisor on their side, care options become much more clear. One member, Brian, was surprised to learn about his options when he needed ACL surgery after he hurt his knee in an accident.

The Solution

Our Advisors take a proactive approach. That’s how Jeanette got in touch with Brian after he hurt his knee. Jeanette received an alert that Brian was in need of an ACL surgery, and had been pre-certified at a nearby high-cost hospital. Knowing that other options may exist, Jeanette reached out to the provider. She discovered that the doctor scheduled to perform Brian’s ACL surgery at the hospital also had privileges at a nearby outpatient surgery center with an identical quality rating. The cost difference was staggering. Both the plan and the member would benefit. The savings to the plan amounted to over $20,000, and the member would pay significantly less out-of-pocket.

Once Brian knew his options, Jeanette worked with him to make sure this was the best choice for his surgery. They discussed a financial reward that Brian would receive for receiving care at the outpatient facility, and Jeanette even recovered reimbursement for the amount Brian had already paid to the hospital. With Jeanette’s guidance, Brian received his ACL surgery at the outpatient facility with his original doctor. Savings totaled over $20,000.

It turns out that good news travels fast. Shortly after helping Brian with his surgery, Jeanette received a call from one of his co-workers to discuss options for her hip replacement. She said that Brian encouraged her call.

*Names have been changed to protect employee privacy

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