What Does Self Fund Health Do Related to J-Code Infusions?

Self Fund Health actively manages J-code infusions, which are some of the most expensive claims an employer will face.

Our approach:

•Site of Care Optimization – We work with members and their physicians to move infusions out of high-cost hospital outpatient departments and into lower-cost sites of care (such as independent infusion centers or home settings) whenever safe and appropriate.

•Preferred Pricing & Cash Pay Options – We have partnerships with providers who offer transparent, fair pricing for J-code drugs and administration. This can mean thousands of dollars in savings per infusion compared to hospital billing.

•Clinical Guidance – Our nurse navigators and DPC providers play a central role, helping members understand their options, coordinating with prescribers, and steering them toward high-value sites of care.

•Real-Time Technology – Pre-authorizations and claims data flag upcoming J-code treatments, allowing us to intervene before costs are incurred.

By aligning clinical guidance with financial incentives, we reduce unnecessary spend while ensuring members receive safe, effective treatment.