Oftentimes a direct discount is either uncompetitive or not available to most employer Groups. Employer Stop Loss and Employer Transplant customers will have the opportunity to access deep discounts through any Tethys Health Network Center or Excellence or through a direct negotiation with a Tethys Health Network Contractor.
Tethys received an advanced specific reimbursement request from a partner TPA under our Employer Stop Loss contract. The size of the claim was $423,181.24 in billed charges. The claimant was receiving services at an out of network facility and the TPA was able to obtain a 25% discount on the out of network claim. A dedicated Tethys Health Network Contractor stepped in and contacted the hospital to successfully negotiate an additional 10% discount—totaling $42,318.13 in additional savings to the customer and to the carrier.
Advance notice of an impending procedure is the absolute best time to contact Tethys for a deeper discount. A partner TPA contacted Tethys several months before a member was to have an invasive procedure performed for a high risk pregnancy. The TPA was not contracted with the provider; however, the center was a Tethys Transplant Center of Excellence. Tethys made a referral to the center notifying them that the patient’s charges were to be filed under the Tethys rate. By the end of the case, the total billed charges reached $2,017,748.60. With the Tethys Discount, the group realized $705,414.80 in savings.
To gain access to the Tethys value-based pricing please Log in.