Healthcare Concierge Case Studies
Best use of cash benefit
A member’s husband called to request a transfer to private hospital for his wife who is undergoing NHS treatment for cancer. Following discussions with one of Healthcare Concierge’s Registered General Nurses, it emerged that the main issue was not the quality of the chemotherapy available on the NHS, but the cost of childcare for the family. The nurse negotiated a 150% increase in NHS cash benefit with the insurer. This meant that while the patient remained in an NHS hospital, the family could also claim for £3,000 cash benefit which covered the child care costs.
The overall saving to the employer’s healthcare scheme was £22,000.
Hospital services covered in full
Our Healthcare Concierge nurse was contacted by the HR team about a member who had recently been diagnosed with cancer and had booked in for surgery at a central London clinic which was not covered by his policy. Owing to the complexity of the operation and his body mass index, two experienced surgeons were required to undertake the procedure and support from intensive care would be required after it.
Full details of the treatment plan were obtained by the nurse who quickly advised that none of the treatment costs would be covered and that potentially the member was facing substantial costs. He would be incurring two consultants’ fees and an anaesthetist charge, as well as a hospital bill which was not covered by his private medical insurance. By negotiating with all parties, the nurse was able to change the hospital arrangements and get all the fees for professional services covered in full leaving no liability for the patient.
As a result of our intervention, considerable cost savings were made. Originally, the first specialist was overcharging guidelines by £900, the anaesthetist by £80 and the second consultant fee would not have been covered at all. In addition, the member would have faced self-funding up to £15,000 in high dependency costs. The nurse also pointed out the availability of the NHS cash benefit to the member which would help towards the cost of his wife staying in hotel accommodation near the hospital.
Cash benefit claimed
A member fractured his leg in a motorcycle accident. He contacted the Healthcare Concierge helpline from A&E, requesting a transfer to a local private hospital.
The nurse was able to advise him that the NHS hospital where he already was had greater expertise in trauma than the private one and he agreed to stay where he was.
The cash benefit claimed by member resulted in a saving of £3,300.
Fee negotiations with consultant
Prior to planned surgery, a member contacted the Willis Towers Watson Healthcare Concierge nurse for advice as the specialist was intending to charge £300 more than the amount allowed by the insurer for the procedure involved.
The nurse negotiated the fees with the consultant who then agreed to reduce the charges to within the cover limits. The member was then able to proceed with the operation.
Had we not intervened, the surgery may have had to be cancelled or the member would have had to pay the £300 shortfall out of his own pocket. A faster return to work was also facilitated.
Invoice waived following sub-standard treatment
£100 EXCESS SAVED
A member of the HR team experienced sub-standard treatment from a hospital. The night before the treatment was scheduled to take place, the hospital was changed and then following the surgery, the member had to then wait for histology results. The Willis Towers Watson Healthcare Concierge nurse contacted the consultant’s secretary to explain what had happened and negotiated that the invoice was waived.
Had we not intervened, the client’s expectations as a patient and the scheme decision maker would not have been met. With the involvement of the nurse, there was no cost to the scheme and the £100 excess did not have to be paid.
Hospital costs challenged
30% REDUCTION IN COSTS
As a result of complications following privately funded surgery, a dependent was admitted to an NHS hospital as an emergency. The patient contacted the Healthcare Concierge helpline following the admission and was advised due to the nature of the complications to stay where he was. The patient became frustrated and requested a second opinion within the NHS hospital and wanted to transfer his care back privately. The consultant who came to see him was a specialist in dealing with the particular complication of his initial surgery, but wasn’t able to help privately for another three weeks. The patient therefore arranged for another specialist to take over his care and an NHS to private transfer took place over the weekend. Healthcare Concierge was not advised this had happened until four days after his admission and it transpired he had gone in to an out of network hospital that was not covered under his insurance.
Arrangements were made to move the patient to another private hospital within his insurance cover limits and immediate measures were put in place with the first hospital to reduce the shortfall to the patient. The Willis Towers Watson account manager was also alerted as the predicted length of stay was going to exceed ten days. We also liaised with the hospital contracts team at the insurer to negotiate with the new hospital to achieve a 30% reduction in costs five days after admission, making considerable savings to the medical insurance contract.
Negotiations were also made with the out of network hospital to reduce his liability for the shortfall of his care. The liability for the member initially totalled £1,731. The Healthcare Concierge nurse immediately put a case to the hospital to try to further reduce the shortfall for the patient and through challenging them they agreed to reduce the shortfall to £1,000. The Healthcare Concierge Nurse still felt this was unfair and wanted to contest it further. A letter of complaint went to the hospital regarding their admission process and the fact that the admissions team should have contacted the insurer when they opened on the Monday morning, thus saving some of the ‘unauthorised’ tests and treatment expenses the patient had incurred.
As a result of the intervention of the Willis Towers Watson Healthcare Concierge nurse, the complaint was escalated to the CEO of the hospital, who agreed to reduce the shortfall to the member to £250. Hopefully procedures have been put in place at the hospital for weekend transfers to protect patients, who at a time of need, are very vulnerable and may not fully understand their insurance and the standard responses of hospital groups who state the costs are “the member’s liability/responsibility”.
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