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$30,000 Pharmacy Claim Reduced to $0

August 7, 2015

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Saved $3,900 and a Lawsuit

August 7, 2015

Jessica’s three-year-old son was rushed to hospital in July for an acute episode of asthma. He was hospitalized for four days. The family received a billing notice from the hospital stating they owed $3,986.86 more than what the insurance had noted in their records. Jessica indicated that the hospital failed to obtain pre-certification correctly and timely, causing Jessica’s family to be penalized. The patient’s Explanation of Benefits (EOB) clearly stated the hospital was to be held responsible and not the patient’s family, which is when she called CarePartner.

 

We called the same day to contest the the bill and it was sent to review. When we spoke with Jessica, who is an attorney, she said, “Nothing good ever happens to me. Everything is difficult and I’m prepared to subpoena you to win this.” After educating her on how CarePartner advocates to get the insurance and billing departments to work together she said, “I guess I should take my attorney hat off and let you do your job. This is hard for me because I’m an attorney and by now the entire hospital would have heard from me. We will see if ‘nice’ works.”

 

Within two weeks, we were happy to call Jessica to tell her it pays to be nice! Within one week of our original call, the review department had identified their error and acknowledged the penalty was theirs, not the patient’s, so the $3,986.86 was down to $0! We not only saved Jessica $3,986.86, but we also saved Jessica the headache of a lawsuit.

 

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