Advocacy in Action | Recovering Claims Denied as Work-Related
After being injured in a hunting accident, a member began to receive outstanding invoices for over $88,000 in unpaid claims. The Member reached out to The Purple Card to inquire why these claims were not paid, stating that they should have met their deductible. At first the claims were pending and asked if the injury was work related. The member completed the requested form numerous time indicating it was not a work related injury. After completing the same form again, the Patient Advocate sent the form to the carrier and they confirmed it was received and claims would process. However, the invoices continued to come in and collection calls started.
After countless emails, phone calls and escalations over several months it was determined that the original claim from the ER visit was coded as a work related injury and caused all following claims to be denied. The Patient Advocate contacted the ER physicians office to have them review the records showing in fact it was not a work related injury and resubmit a corrected claim. Once that claim was reprocessed, the Patient Advocate then had all claims after the ER date of service reprocessed. After several more emails and calls, the Patient Advocate received notice with an updated claims spreadsheet outlining all claims from the date of the injury to current and how they processed. When all was said and done, the Patient Advocate recovered $88,883.04 for the member.
At Brinson Benefits, we care about the patient’s best interest. We believe the patient should have an available healthcare navigator and advocate. Our Patient Advocates at The Purple Card® are highly trained to educate members about available benefit programs. They work hard to resolve issues with providers and insurers.
The Purple Card® is an independent health care advocacy and assistance service. Our Patient Advocates provide time and cost-saving services to resolve concerns about benefit programs. We not only assist our members, we educate them on ways to maximize health care coverage and other available benefit programs.
