Emry Team Appeals Required Out-of-network Surgery Costs for Employee

Situation

With no other options in their geography, an employee of an Emry client utilized an out-of-network provider for laparoscopic surgery and was faced with bills large enough to put their family in medical debt.

Service Provided

The Emry team reviewed the bill and determined the insurance erroneously denied charges. Insurance policies pronouncements, clinical policy bulletins, and the surgeon’s supportive documents were utilized to appeal the claim decision on the grounds that the case was medically necessary and no in-network provider in the geography was qualified for the surgery required.

Savings

After several attempts with the hospital, Emry successfully secured a settlement amount of $2,995 as payment in full. Emry saved $5,403 or 64% off on the total bill. As the employer was going to pay the bill for the employee, this saved the employee and client $5,403. To provide additional value, we obtained a financial assistance application and assisted in the completion for the client as a secondary option.

Topics

abc

Get started with Emry

Contact us today to learn how Emry can drive value for both you and your employees.

Suggested Case Studies

Hospital Financial Assistance: Employee Cost Avoidance

After a hospital stay, an employee with a MEC plan and no hospital coverage received an unaffordable bill for $77,000. Using Emry’s financial assistance technology, the employee qualified for and obtained hospital financial aid, which covered 100% of the bill. This intervention saved the employee from substantial medical debt, totaling $77,000 in savings.

Learn More

Ready to See Emry in Action?

Send us a note and we’ll respond just as quickly as our helpful guides do for your members. Don’t want to wait? Give us a call.

Still Browsing?

View Our Solutions