High-Cost Bill Review: Out-of-Network Hospital Admission
A member experienced a mental health episode and was taken by ambulance to their local hospital. They were subsequently admitted to the hospital for over 3 days. Unfortunately, the hospital was out-of-network, and the member received an unexpected bill of $35,400.
The Emry team conducted a thorough bill review, determining that the hospital processed an internal pre-authorization for inpatient services and the member was not of sound mind to give approval. Emry ensured that the bill was reprocessed as in-network, subject to the remaining in-network deductible and coinsurance.
Thanks to Emry’s intervention, the member saved $33,000. This assistance not only alleviated the financial burden but also ensured that the member received necessary healthcare without additional financial stress.
Suggested Case Studies
A member visited the emergency room and required a CT scan and other major medical tests. Following their visit, they were faced with two significant bills, totaling over $38,000.
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