Large Insurer Achieves Savings Through Clinical Bill Review

This case study outlines the collaboration between a large insurance company and Vālenz Health to optimize healthcare costs through a clinical bill review. The insurance company, which insures nearly three million union members, faced significant charges related to a member's treatment for lymphoma and leukemia, amounting to nearly $2.5 million. With an allowable cost of approximately $1.8 million, the situation involved high-cost prescriptions and billing discrepancies. To address these challenges, the insurer engaged Vālenz for a line-item bill review. The Valenz provider relations team conducted a thorough assessment of the charges, identifying potential savings through clinical opportunities and billing errors. This collaboration resulted in a total savings of $1.1 million, achieving 57% in savings above the PPO allowable. The case emphasizes the importance of early engagement and communication with healthcare providers to secure significant cost reductions.