REMOVE DIALYSIS TREATMENT FROM COVERAGE UNDER YOUR PPO NETWORK “Why would I do something like that?!” 1. You continue to receive claims for dialysis and continue to pay extremely high rates – as high as $70,000+ PER MONTH. 2. You continue to receive NO help from the PPO Networks. Even AFTER PPO reduction, the charges remain $15-$20,000/month and they REFUSE to allow your self-funded clients under ERISA plan designs to exercise their Fiduciary Responsibility. 3. You have discussed this issue with your TPA, the Plan Sponsor, the PPO Network and your Re-insurer each and every year to find a solution. 4. Yet today, you still have the same issues. Your dialysis patients continue to treat. The dialysis market continues to be controlled by 2 groups, and you continue to pay these massive rates. USE THE LEVERAGE OF YOUR ERISA PLAN DESIGN TO IMPLEMENT THAT SOLUTION 1. Plan Sponsors move to a self-funded plan design to GAIN CONTROL over their health plan. Yet, the Networks are not allowing the sponsors to exercise that basic right. 2. Under ERISA and a self-funded plan design, the sponsor has no obligation to offer a PPO network at all. 3. Given that fact, there is no obligation to offer PPO coverage for ALL types of medical treatment either. HERE IS THE SOLUTION! 1. Nearly all self-funded SPDs have Out-of-Network reimbursement language that supports UCR and Reasonable reimbursement levels. 2. With Dialysis removed from the PPO, ALL dialysis claims are now Out-of- Network. 3. With the SPD supporting our Referenced Based Pricing and Clinical Review claims settlement approach for these now Out-of-Network claims, Relevant Healthcare can reduce those claims significantly (average is $20,000 per month), and do so WITH NO RISK TO THE SPONSOR OR THE PATIENT. 4. Based upon the rules/regulations surrounding dialysis treatment, a patient that has Medicare designated as Secondary coverage (this occurs after 3

Relevant healthcare dialysis solution

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Having challenges from your PPOs in finding a way to decrease your costs of dialysis? Here is a solution!

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Page 1: Relevant healthcare dialysis solution

REMOVE DIALYSIS TREATMENT FROM COVERAGE UNDER YOUR PPO NETWORK“Why would I do something like that?!”

1. You continue to receive claims for dialysis and continue to pay extremely high rates – as high as $70,000+ PER MONTH.

2. You continue to receive NO help from the PPO Networks. Even AFTER PPO reduction, the charges remain $15-$20,000/month and they REFUSE to allow your self-funded clients under ERISA plan designs to exercise their Fiduciary Responsibility.

3. You have discussed this issue with your TPA, the Plan Sponsor, the PPO Network and your Re-insurer each and every year to find a solution.

4. Yet today, you still have the same issues. Your dialysis patients continue to treat. The dialysis market continues to be controlled by 2 groups, and you continue to pay these massive rates.

USE THE LEVERAGE OF YOUR ERISA PLAN DESIGN TO IMPLEMENT THAT SOLUTION

1. Plan Sponsors move to a self-funded plan design to GAIN CONTROL over their health plan. Yet, the Networks are not allowing the sponsors to exercise that basic right.

2. Under ERISA and a self-funded plan design, the sponsor has no obligation to offer a PPO network at all.3. Given that fact, there is no obligation to offer PPO coverage for ALL types of medical treatment either.

HERE IS THE SOLUTION!

1. Nearly all self-funded SPDs have Out-of-Network reimbursement language that supports UCR and Reasonable reimbursement levels.

2. With Dialysis removed from the PPO, ALL dialysis claims are now Out-of-Network.3. With the SPD supporting our Referenced Based Pricing and Clinical Review claims settlement approach for

these now Out-of-Network claims, Relevant Healthcare can reduce those claims significantly (average is $20,000 per month), and do so WITH NO RISK TO THE SPONSOR OR THE PATIENT.

4. Based upon the rules/regulations surrounding dialysis treatment, a patient that has Medicare designated as Secondary coverage (this occurs after 3 months of treatment), A FACILITY CANNOT BALANCE BILL A MEMBER AS LONG AS THE FACILITY IS GETTING PAID MEDICARE RATES OR HIGHER.

5. Any Appeal sent to the Sponsor or TPA from the facility on a reduction of charges is handled and supported by Relevant Healthcare.

OUR SUCCESS RATES ON SECURING SAVINGS ON DIALYSIS ARE NEARLY 100%! IF THE PROCESS ABOVE IS FOLLOWED, YOUR CLIENT COULD EXPERIENCE THE SAME VALUE AND

SAVE HUNDREDS OF THOUSANDS OF DOLLARS EVERY YEAR, AS WELL AS SAVINGS ON STOP LOSS RENEWALS.