Wellfleet designs its health insurance plans specifically for students, paying attention to the unique needs of the student population. A major consideration for students is the cost of care. Students are already dealing with the expense of college, so keeping healthcare costs low is important because it helps them access the care they need.
Wellfleet Student diligently searches for ways our students and schools can save money. One strategy we use is claim review. In this process, we review claims closely and check for billing errors. If we find a mistake, we correct it, often resulting in significant savings.
In this blog, see how our team fixed an inflated bill for the birth of a baby, which led to school plan savings of $43,627 dollars!
The case study
One of our student members welcomed a baby into their family. The healthy baby was born without complications at 38 weeks and two days gestation. After a smooth recovery, the baby headed home with its parents two days later.
All appeared normal, but when Wellfleet received the bill for the baby’s hospital stay, we noticed some discrepancies. The diagnosis-related group, or DRG, for the baby, was “Neonate with other significant problems.”
However, the only minor complication noted with the newborn was called meconium staining, meaning the baby’s feces were present in the amniotic fluid. This can occur in 12-20% of deliveries, according to the Cleveland Clinic.1 Some babies ingest meconium-stained fluid, which is not concerning.1 However, respiratory complications can arise if a baby inhales meconium into their airways.1
In this case, the baby did not ingest or breathe in the meconium, and no complications arose from the presence of meconium in the amniotic fluid, so the correct DRG should have been “Normal newborn.”
How our team fixed the billing mistake
After our Payment Integrity team determined that the DRG was incorrect, we changed the coding to “Normal newborn,” which resulted in significant savings for the school plan.
School plan savings
The initial bill for the baby’s care was $46,395, but after our team corrected the errors, the plan cost was reduced to $2,767. This resulted in plan savings of $43,627 for this baby’s care.
The downstream effect of this plan savings is reduced yearly plan spend for the school, which can decrease future premium increases, helping to stabilize insurance costs for students.
How our team saves money on claims
The Wellfleet team understands how important it is for students to get healthcare at an affordable cost. That’s why we take a multi-pronged approach to reducing costs for students, including:
- Availability of 40+ medications with a $0.00 copay
- Access to robust telehealth services
- Use of prior authorization, quantity limits, and step therapy
- Careful review of high-dollar claims
Learn about our True Choice Student Health Plan, which further reduces healthcare costs for students while increasing provider choice.
One way that Wellfleet Student goes the extra mile for our students is that we employ a thorough review process of our high-dollar claims. When our team receives a large claim, we take the time to review it manually to ensure that the billing and charges are correct.
Many health plans approve claims without review, which means that costly errors are often left unnoticed. At Wellfleet, we analyze every high-dollar claim we receive to ensure no mistakes or overcharges are present. If we find a mistake, we review the claim in depth, identify the correct billing for the claim, and work with the provider to come to a resolution. Our attention to detail with claims saves money for our students as well as our school plans.
Committed to college students, we work hard to keep costs low and provide care that fits our students’ budgets.
Read another savings case study, where we found $210k in plan savings on the birth of twins.
Learn more about Wellfleet Student
To learn more about developing a tailored student health insurance plan that puts you and your students first, reach out to our Sales team.
References
1 Cleveland Clinic. (2022, September 7). Meconium. https://my.clevelandclinic.org/health/body/24102-meconium.
CSR-SHIP-APRIL-2024-01
