A Manufacturer in Wisconsin had an employee with chronic disc pain causing severe and regular pain to the neck. After repeatedly seeking various types of non-surgical treatment, the pain worsened and the doctor recommended cervical disc surgery as part of a long-term solution.

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Cervical disc replacement can be very expensive. The state average in Wisconsin is $50k per cervical disc surgery, which combined with other treatment required would have exceeded the specific stop loss coverage for the employee and could have had significant impact on reinsurance rates the following year. The employee was also facing substantial out-of-pocket costs, which would have created a difficult financial hardship.

BPA went to the market to determine what savings were available. We quickly found a provider in the Minnesota metro area that was willing to complete the procedure for half of the state average, at $25k. However, BPA also has relationships with vendor partners who offer bundled pricing for certain types of surgeries and was able to contract with a specialty vendor to save the member and employer even more.

By using its vendor network, BPA secured a cost of the cervical disc replacement for just $9k, an 82% reduction in real cost.  Furthermore, the plan was realizing such substantial savings that the employer was able to offer 100% coverage with no deductible to the employee if they were to utilize the cost-effective provider. The employer saved substantially in the short-term and even more by avoiding the increase in stop loss rates the following year. The member obtained the needed care at no out-of-pocket cost, making it a symbiotic win for all parties involved.

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