Reducing out-of-network healthcare spend by ~91%
Challenge
A technology-focused durable medical equipment company with 652 enrolled employees, was facing rising healthcare costs driven by out-of-network claims and inconsistent provider billing. The organization needed a solution that could meaningfully reduce unnecessary healthcare spend without disrupting employee access to care or increasing administrative burden on internal teams.
Like many employers in the technology and innovation space, maintaining competitive benefits while controlling long-term healthcare costs has become increasingly important in attracting and retaining talent.
Solution
Pinnacle implemented an enhanced out-of-network negotiation and cost containment strategy focused on identifying savings opportunities across eligible claims.
Working closely with the employer, Pinnacle helped:
- Review and negotiate high-cost out-of-network claims
- Reduce excessive billed charges
- Improve overall claim efficiency
- Deliver savings without requiring disruptive plan changes
- Maintain a positive employee benefits experience while improving cost visibility
The strategy allowed the employer to gain stronger control over healthcare spend while continuing to offer competitive benefits to employees.
Highlight Stats
- Approximately 91% savings achieved on eligible reviewed claims
- $1,147,033 net savings after fees
- 324 claims reviewed
- 652 enrolled employees
- Significant reduction in unnecessary out-of-network spend
- Improved overall cost management without reducing employee access to care
Results
Achieved approximately 91% savings on reviewed claims
Through enhanced negotiation and cost containment strategies, Pinnacle helped dramatically reduce billed charges on eligible out-of-network claims. With 324 claims reviewed, the employer achieved more than $1.1 million in savings while maintaining employee access to care and avoiding disruptive plan changes.
Reduced unnecessary healthcare spend without disrupting benefits
Rather than shifting costs to employees, the strategy focused on identifying savings opportunities behind the scenes. This helped preserve employee satisfaction while improving overall plan efficiency.
Delivered a streamlined employer experience
Pinnacle partnered closely with the employer to provide reporting visibility, claims support, and hands-on service throughout the process, helping reduce administrative burden for the HR team.
See how Pinnacle Health Solutions can help you
Reach out to learn how Pinnacle helps tech employers control rising healthcare costs through enhanced cost containment solutions.
