Patient Navigator breaks through a logjam of $80,000 in medical claims and reduces the obligations of our client to $175.
Maria engaged Patient Navigator to remedy a four-year logjam of unpaid medical claims totaling $80,000 in provider billings. The situation required discussions with Medicare, the Social Security Administration, a state civil service commission, and two group health plans for retirees that did not coordinate efforts to provide Maria with the coverage she should have received. First, Patient Navigator assisted Maria in enrolling in Medicare Part B and terminating one of her retiree health plans. Then, Patient Navigator worked with her other health plan to have all outstanding claims processed correctly. Finally, Patient Navigator negotiated settlements with many of Maria’s health care providers and had her removed from collection agency dunning. Results: the insurer claims gridlock was resolved and Maria’s total provider obligations were reduced to $175.
Patient Navigator saves our client $15,936 by negotiating a 50% discount on medical bills.
Our client was not insured. Unfortunately, he was hospitalized after an accident and incurred enormous hospital and doctor bills. He was very anxious about the situation, the stress of which was impeding his recovery. Patient Navigator worked with the hospital billing office and secured a 50% discount on his outstanding hospital. His doctors then also also reduced their bills by 50%, saving thousands more.Our client saved $15,936 just from his hospital bill and avoided bankruptcy. Elisabeth handled negotiations quickly, professionally and forcefully resulting in a 50% discount across the board…She has saved me tens of thousands of dollars and most importantly, she provided wonderful personal support and empathy as I struggled to not only heal from my injuries and surgeries but to also deal with my providers. Her support greatly enhanced my self esteem and confidence.”
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!”
Patient Navigator saves client over $9,000 by cutting bill in half.
An uninsured, non-English speaking patient came to us in desperation after an emergency hospital stay. Her hospital bills were over $18,000 and she was at a loss. Patient Navigator intervened to negotiate a 50% reduction of the hospital bill, a discount her doctors then honored as well. A payment plan was set up and the client feels more secure about her financial future now.
Negotiating a $3,639 discount on a diagnostic lab test – saved 82%.
The client had an overdue bill in the amount of $4,139 from a diagnostic testing lab that had been past due for over one year. The client had tried to appeal insurance denials on her own, to no avail, and the bill was sent to a collections agency. Patient Navigator intervened with the lab to negotiate a settlement of $500 as payment in full. The lab agreed to this, pulled back the bill from collections and the issue was resolved. The client saved her credit report and $3,639.
Medical bill negotiations save family $10,000.
When his daughter-in-law’s uninsured hospital bills were coming due, Patient Navigator helped our client seek financial assistance and an audit of the invoice, which revealed multiple duplicate and unsubstantiated charges. The hospital issued a clean bill with a 50% debt reduction. Another bill was already with debt collectors, but Patient Navigator negotiated a 70% reduction and the bill was settled. The family appreciated our dogged persistence and the nearly $10,000 in savings we earned for them.
A family finally wins.
A family with a medically fragile young child struggled for years with its insurance company to obtain the care, treatments and equipment the child needed. They were overwhelmed with all the paperwork, denials, missed payments and constant roadblocks erected by the insurer. When Debora Harvey, our insurance specialist, got involved, we began a systemic effort to sort things out. The final victory came in a meeting with the insurer, the employer and the family during which Patient Navigator produced reams of documentation to prove the insurance company’s obstructionism, mistakes and shenanigans. As a result of that meeting, the insurer provided a personal, high level representative to solve problems and to implement systems so that this family’s claims would get paid fully on time. The family wept with gratitude and the new system is working smoothly.
Victory in insurance appeal allows teenage girl to get help.
A teenage girl was suffering from a debilitating, but little-known, mental illness. Despite her parents’ persistent efforts to obtain the specialized services she needed following several emergency hospitalizations and treatment attempts, the insurance company refused to allow treatment in the one hospital equipped to help. After futile efforts through the insurance company’s internal appeal process, the family turned to Patient Navigator. We immediately prepared a detailed, documented case and appeal submitted to the Insurance Commission and Ombudsman of that state. The appeal was again denied, but Patient Navigator lodged another level of appeal. The insurance company finally agreed to cover the hospitalization that would save this teenager. She has returned to school after missing an entire year while the insurance company refused to help her. Her parents said, “Words cannot express how fortunate we are that we hired Patient Navigator to advocate on our behalf in dealing with a denial of medical service for our daughter. They were well organized, professional, familiar with medical insurance policies and guidelines, and dedicated in providing the best advice and information possible to ensure a successful outcome. They showed compassion in their work and for our family, they truly cared. Our daughter is being treated at the right hospital now, and she wouldn’t be if not for Patient Navigator’s help.”
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.