An Amerisure claimant needed a new prosthetic leg, so Amerisure reached out to get a quote from the vendor that provided the claimant’s last prosthetic in 2018.
Amerisure sent that quote to their partner Optum to verify if the quote was reasonable and the particular prosthetic was clinically appropriate.
Amerisure saves 51% on prosthetic leg
Key outcomes
- The importance of sending quotes through Optum before authorizing
- Dramatic $26K savings on high-cost durable medical equipment
Challenge
The need to evaluate the quote for appropriateness and cost. The quote was extremely high, likely due to the prosthetic provider assigning a miscellaneous code to the order.
Solution
Optum confirmed appropriateness and negotiated the miscellaneous code with the prosthetic provider who is in the Optum network.
Result
With the negotiated code, Optum was able to cut the quote by $26,000, a 51% reduction.
This savings underscores the importance of running a quote through Optum. We realized a sizeable reward – larger than we would have expected. We will continue to have Optum validate products and quotes to make sure that we’re meeting the needs of injured workers and doing it in a cost-effective way.”
Amerisure adjuster