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Medical Bill Resolution Saves Employee $34K in Healthcare Costs

How Emry Resolved an Insurance Error for a Client’s Major Cancer Surgery

Situation

An employee of an Emry client was facing a major health battle and was focused on getting healthy – not on whether their cancer specialist was in or out of network. Unfortunately, an out-of-network surgeon was used for their major cancer surgery and the resulting cost was $37,200.00. The insurance provider erroneously processed the claim as in-network, resulting in a reimbursement of only $3,000.00 to the provider. As a result, the employee received an upsetting balance bill from the provider for $34,200.

Service Provided

The Emry team conducted a thorough analysis of the medical bills to identify discrepancies through a comprehensive bill review, the explanation of benefits, and the full medical report where we uncovered that the treatment was incorrectly processed. Our experts re-submitted the claim to the insurance provider to correct the error. Leveraged our BillAssist platform to streamline the bill negotiation process and this claim resubmission resulted in an additional out-of-network payment of $9,000.00 – but still leaving the employee on the hook for $25,200.

To secure additional coverage for this claim, the Emry team had to file 2 appeals which demonstrated that the surgery was very complicated, required a full medical team, and took 8 hours to complete which proved the breadth and life-saving nature of surgery.

Outcomes

The first appeal was denied. But the Emry team filed a second appeal which resulted in an additional payment of $28,200.00 as the deductible and out-of-pocket maximum were reached. As a result, insurance covered 100% of the surgery and the employee saved $34,200. This case highlights the importance of effective medical bill resolution services and our solutions for employer groups.

Total Savings:

$34,200

Topics

CareCost Save, Employee Impact

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