For Self-Insured Employers
Reduce Your High-cost medical claims by 50-70%. Give your employees $0 out-of-pocket access to comprehensive care.
Get a savings estimate for your plan - Savings Form
Download the program over view - Program Overview
Contact Us For More Information!
Your Highest-Cost Claims are also Your Most Variable
Orthopedic and spine procedures are some of the most expensive and most unpredictable claims for self-funded plans. Hospital-based facility fees, surprise bills, multiple separate charges from surgeon, anesthesia, and facility, and aggressive chargemaster pricing combine to produce six-figure claim variability that no actuary can model cleanly. Direct contracting fixes the variability at its source. One bundled rate, negotiated directly with your plan. All-inclusive. Paid in full without repricing. The chart shows the kind of savings our current partners typically see — your actual rate schedule is built specifically for your group.
What Direct Contracting Typically Saves an Employer Plan
Hospital ranges reflect regional facility-fee averages and published chargemaster comparisons. Savings ranges shown are illustrative of outcomes seen across our current direct-contract partners; your actual savings will depend on your negotiated rate schedule, plan design, and case mix. Each Aptiva direct contract is custom-built for the employer plan it covers.
Frequently Asked Questions About Direct Contracting
Q: Do we have to drop our existing PPO to use a direct contract with Aptiva?
A: No. Aptiva's direct contracts are non-exclusive. They stack alongside your existing PPO networks and other vendor relationships. Your plan simply designates Aptiva as a Tier 1 preferred-cost option for in-scope services.
Q: How do we waive employee cost-share for Aptiva services?
A: Your TPA or administrator updates the plan document to designate Aptiva as a Tier 1 / preferred-cost-share provider, with copay, coinsurance, and deductible waived for in-scope services. Aptiva can supply suggested plan-document language.
Q: What is the minimum group size for a direct contract?
A: There is no minimum. The Direct Medical Services Agreement is structured to work for self-insured groups from a few hundred to several thousand covered lives.
Q: How long does it take to go live?
A: Typical implementation is 30 to 45 days from agreement signature to first eligible claim. The path is: discovery call, plan-document review, agreement signature, BAA execution, eligibility file share, go-live.
Q: What is excluded from the direct contract?
A: Workers' compensation claims and auto/PIP injury claims are excluded. An Aptiva practitioner will still coordinate care with the appropriate provider for those cases.
Q: How quickly are clean claims paid?
A: Claims are submitted on HCFA/CMS-1500 within 180 days of date of service. Clean claims are paid within 30 days of receipt, with no repricing applied.
Q: Is there a standard Aptiva rate sheet, or are rates negotiated per group?
A: Each Aptiva direct contract has its own rate schedule, built specifically for the plan it covers. We base the schedule on your claims profile, group size, benefits structure, and which service lines you want in scope. You review and approve the full rate exhibit before signing — there is no hidden pricing.
Q: How do we evaluate the savings for our specific plan?
A: Send us anonymized claims data — high-cost claims, surgical utilization, and member counts — and we will model the projected savings under a custom-built rate schedule for your plan. The conversation starts with a 20-minute discovery call.
Run the Numbers on Your Plan
Send us anonymized claims data and we’ll model the projected savings under your plan. Schedule a 20-minute discovery call, no obligation.
HIPAA notice: Do not include protected health information in this form. Aptiva Health will execute a Business Associate Agreement before any PHI is exchanged.