The Issue
One of our clients had complained to us at a monthly review session that they were spending a great deal of time fielding questions from a few of their employees about the large balances they were responsible for after the health insurance carrier reimbursed a provider for services.
Our Solution
We instructed the human resource director to have any employee questioning their balance bill send our claim team the supporting documentation via secure email. Our experienced team would intervene and assist the employee in their investigation of the claim issue. Knowing that there is a high incidence of errors in medical billing and with their experience, they know where to look, what to look for and how to resolve the problem. Most frequently, the provider needs to be contacted to correct an incorrectly used medical billing code.
The Result
After reviewing all the claim issues, we found that although some of them were submitted and processed correctly leaving the patient with a responsibility to pay the difference, there were, in fact, many that contained errors. After contacting the providers and having them correct the mistakes, the claims were reprocessed and the carrier sent out a revised explanation of benefits form. In total, for the 17 employees we worked with, we were able to save over $33,000 in out-of-pocket expenses. To educate all employees, we have designed and distributed a communication piece specifically for this company with instructions on what an employee should look for and how to resolve these issues on their own. Of course, when necessary, we continue to assist anyone who needs help.