How One Employer Avoided a $27K Hospital Bill with a $10,200 Outpatient Solution

Written By: Joshua MacFall

Published: July 1, 2025

Who is this case study for?

Brokers and TPAs managing regional facility cost variation

At-a-Glance

Procedure Type: Colecistectomía laparoscópica

Total Bundle Price: $10,200

Typical PPO Allowed Amount: $35,000+ (hospital-based)

Savings to Employer: $25,000

Time Off Work: 7 days

Location: San Antonio, TX

El problema

A national food service company with 600+ employees in Texas had repeatedly seen emergency gallbladder cases routed to hospital outpatient departments—triggering $30,000–$40,000 claims for what should be a straightforward, low-complication procedure. These events also created stress for employees, often involving multiple billing departments and high out-of-pocket costs. The employer wanted a solution that could intercept these cases early and offer a clear path to care.

The Turning Point

When another employee reported persistent abdominal pain and was advised surgery, the employer—through its TPA—redirected care through TMM’s surgical concierge. Within 24 hours, the patient was evaluated by a participating surgeon and scheduled for surgery at a local ASC, avoiding the hospital entirely.

The Solution

TMM coordinated a bundled surgical episode priced at $10,200, which included surgeon, facility, anesthesia, pre-op labs, and all post-op visits. The patient was seen within one day and underwent surgery the following week at a low-acuity ASC designed for fast discharge and minimal disruption. Post-op recovery was uneventful, and the employee was back to work within seven days.

The Outcome

The plan avoided a projected $35,000+ claim by routing care through TMM’s bundled pricing model. There were no facility escalation charges, no ER utilization, and no balance billing. The employee reported high satisfaction with the experience—and the employer now flags gallbladder cases for early bundle routing to preempt costly ER episodes.

Strategic Insight

Gallbladder surgeries are a prime example of how plan design isn’t the problem—plan routing is. With TMM’s proactive care coordination and price-transparent bundles, employers can prevent unnecessary ER admissions and shift surgical care to high-quality, low-cost settings. For TPAs and brokers, this shows how even “routine” cases can become opportunities for significant impact—when the plan has a smarter first step.

Testimonial

“We’ve had multiple gallbladder claims hit over $30k with the exact same outcome. This time, we solved it for a third of the cost—and with better employee feedback. That’s a win.”

Peter Bosch, HR Director

Food Services of South Texas

Navegación

Datos de contacto

Teléfono: (512) 275-6471

DIRECCIÓN:

1001 S Mays St #205 Round Rock, TX 78664

Condiciones de uso política de privacidad

¡IMPORTANTE! Toda la información presentada en este sitio web está destinada únicamente a fines informativos y no con el propósito de brindar asesoramiento médico. Las declaraciones hechas en este sitio web no han sido evaluadas por la Administración de Drogas y Alimentos. La información aquí contenida no pretende diagnosticar, tratar, curar o prevenir ninguna enfermedad.

Our Services

Who We Serve

Precios de paquetes

Our Specialists

Resources