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.
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