Patient Navigator

Patient Navigator Saves Clients Money

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Patient Navigator won a $27,580 insurance on behalf of our client.

After months of appeal, letters, phone calls, a well-documented complaint lodged with the State Insurance Commissioner, repeated and diligent pressure and follow-up, Patient Navigator convinced a major mental health insurer to cover its share of 4 weeks of inpatient treatment for our client. His family received $27,580 the full amount allowable under his insurance plan. He wrote us to say “You are a hero, a champion, a medalist, a gladiator!”

Morris needed help as his wife was recovering from multiple traumatic injuries after a life-threatening accident.

When her rehabilitation insurance benefits ran out, Patient Navigator successfully negotiated with the nursing home to reduce the facility’s private-pay daily rate. The nursing home even agreed to include physical therapy services in the reduced rate.  Morris saved $5,250 for his wife’s 30-day private-pay rehabilitation –  a 41% savings over what they would have paid without Patient Navigator’s intervention.

Patient Navigator unraveled an impenetrable paperwork error to win an insurance appeal worth over $1,400 for our client.

The client’s tests and surgeries had been improperly billed to the insurance company by the hospital.  The client was subsequently sent overseas for work, and had no idea the claim had not been paid.  It wasn’t until bill collectors started calling him that he realized something was wrong.  Patient Navigator solved the problem.  The claim was paid and the bill collectors stopped calling.

Melinda’s elderly parents were flooded with conflicting invoices from hospitals and rehabilitation centers.

Melinda was already overwhelmed by the demands of her young family and career, and did not have time to deal with these billing and insurance problems. Patient Navigator met with her parents, reviewed hundreds of pages of bills and insurance statements, and found the problem. After Patient Navigator worked with the rehabilitation center and insurance companies, the insurers paid the $13,000 discrepancy and Melinda’s parents owed nothing more.

Matthew was dealing with a chronic and painful condition.  To make matters worse, his insurance company would not pay for to cover $1,617 for a series of medically necessary physical therapy treatments.

Patient Navigator was told by the insurance company that the therapy services were not covered because pre-authorization was required and not been obtained beforehand.  The Navigator escalated to a supervisor who finally confirmed that retroactive pre-authorization was possible, but rarely approved.  Patient Navigator re-submitted the claims on Matthew’s behalf and after weeks of follow-up phone calls, the retroactive pre-authorization was unexpectedly granted. Since Matthew had paid out-of-pocket, the Navigator worked with the office manager to redirect the insurance payment back to Matthew.  Ten days later, Matthew received a reimbursement check from the physical therapist for the $556 covered by insurance.

Medicare refused payment for Carrie’s expensive procedure that had been miscoded by the hospital.

Carrie tried to ask the hospital billing department correct its own error.  Not only did the hospital refuse to admit their error, they pursued Carrie personally for payment. The day after Patient Navigator intervened with the hospital’s CEO, the problem was solved in Carrie’s favor, saving her $4,000. Carrie told us “Oh! My! My! This problem would not have been resolved without you! Thank you for giving me hope.”

The Smith family of six includes a special needs child.

They had fallen nine months behind in filing her insurance claims.  The family was thousands of dollars out-of-pocket. Patient Navigator organized and computerized their insurance claims, Explanation of Benefits and invoices, and went to work with the child’s healthcare providers. We filed the insurance claims and appeals, which were complicated for this child’s services. The Smiths received $8,000 in insurance payments they would otherwise have lost.