Case Study: Out-of-network
Maximizing ROI with Creative Solutions
How a northeast brokerage saved their clients $317 million on OON coverage
Problem
A northeast brokerage came to Reliant in 2017, in search of a better savings solution for their employer health plan clients. At the time, they were using either the state insurance fund for out-of-network (OON) coverage, or Blue Cross. They found that both options were becoming too expensive for their clients, as well as delivering inconsistent results. The brokerage wanted to recommend a better alternative for their clients.
Solution
Both the brokerage and their TPA were especially mindful of healthcare provider acceptance rates. So Reliant collaborated with multiple stakeholders to create a custom solution that met everyone’s needs. The TPA leveraged Reliant’s solution to fill their out-of-network gap, providing primary network-like discounts and a streamlined experience for the broker’s clients.
Results
This approach generated considerably better savings with far fewer appeals than the state fund and Blue Cross options. In fact, the average savings rate for the Broker’s clients climbed from 61.7% off billed amount in 2017 to 76.3% by 2023, with appeals rates falling from 3.15% to 0.20% over that timeframe!
Access to Reliant’s one-of-a-kind services has become a unique selling point for this broker, consistently helping them win new business. This has resulted in significantly increased volume year over year priced through Reliant, all of which sees better savings and appeals rates each year as our system learns from each claim. All told, we’ve helped the broker save their clients over $317 million, and counting.
“Reliant has been a great arrow in our quiver for winning new business. They are a fantastic alternative to other, more disruptive re-pricing solutions. Reliant has made all the difference for many of our groups. Our customers see the value Reliant delivers over the long-term.”
– Donn Duhon, Vice President of Business Development, Employee Plans