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T 908-363-1405
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Independent Health Care Advisors LLC
500 Morris Avenue - Suite 201
Springfield, NJ 07081
"IHCA has grown to be a leader in the medical cost containment field, producing some of the highest documented savings in the industry"
Choose any one of the case studies below to view actual savings.
Patient's antibiotic dose was 9 vials daily for 10 days. An IHCA staff pharmacist uncovered blatant price gouging on claims that had already been paid. With a PPO discount of 30%, each vial was billed and paid at 5 times the current AWP price. IHCA immediately contacted the provider for a refund. The provider promptly refunded more than $10,000!
A patient was administered a specialty drug during surgery which resulted in a claim totaling $65,271. The IHCA staff pharmacist performed a clinical review of the claim. Based on IHCA's billing and reimbursement expertise, IHCA was able to negotiate a 50% discount with the provider, resulting in a net savings of $32,635!
A claim was sent to IHCA after it had been internally scrubbed by the payer. The IHCA staff pharmacist reviewed the claim and immediately questioned the dose which was outside of the manufacturer's dosing guidelines. It was determined by the IHCA staff pharmacist that the dose reflected on the claim would have been lethal to the patient. IHCA worked with the provider’s internal medical review department to review additional claims for the same drug administered at the facility which uncovered 2 billing errors of $30,000 each resulting in a savings of $60,000!
Over a course of 10 months, a patient received a high cost medication with claims totaling $325,947. The monthly claims ranged from $39,025 to $74,730. IHCA's staff pharmacist immediately contacted the provider for a detailed explanation of the charges. IHCA reviewed the existing contract for prior billed charges of $325,947 and negotiated a settlement of $79,807. The next step was for IHCA to negotiate a long term agreement with the provider since the patient would be on this drug regimen for the rest of their life. The long term agreement resulted in a savings of $246,139 over the next 12 months!
An employer group and TPA contacted IHCA's pharmacist to seek assistance with a high cost infusion therapy patient. Due to the costs associated with this patient, the employer group was facing excessive increases in their insurance premiums for the upcoming year.
IHCA's pharmacy team performed a comprehensive case review. IHCA recommended a Site-of-Service solution utilizing IHCA's Specialty Pharmacy Distribution Network. IHCA coordinated the change in the Site-of-Service and delivered a healthy outcome for the patient. The yearly savings to the employer group totaled $421,625, thus allowing the employer group to obtain reasonable renewal rates.
Patient was receiving a weekly home infusion for an alpha1-proteinase inhibitor. The insurance company was charged $70,259 a month. Since this was a limited distribution medication, the insurance company thought there wasn’t a cost saving alternative available for the patient. IHCA utilized its Specialty Pharmacy Distribution Network and had the drug supplied for $22,361 a month. Due to utilizing IHCA's Specialty Pharmacy Distribution Network, the monthly savings totaled $47,897 with a yearly savings of $574,771!
A patient was receiving a weekly infusion of IVIG. The existing PPO contract reflected the typical 5% discount. IHCA reviewed the provider’s billed charges which were $22,792 a week. Based on industry standards and reimbursement methodology, IHCA found the charges to be unacceptable. IHCA successfully reduced the medication charges and attained documented savings of $17,570 a week, or $70,280 a month, or $843,360 a year!
