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  For the self insured
  Health Plan Navigatortm audit success stories
 
In each of the success stories below, the companies were unaware there was anything amiss when the paid their health claim claims. Think of losing these amounts every year!

The longer you wait to call us, the more money you are losing from your bottom line.

Still not convinced?

  • We uncovered that a transplant patient was billed for three parts of an implant when the implant had only two parts. The cost of the implant was reduced by 1/3.

  • A patient with a kidney stone was charged for two procedures he never had. He was also charged for six hours in the recovery room when he was ready to go home within 45 minutes. Immediate savings: $4500.

  • A patient was billed for six doses of a very expensive immunoglobulin preparation. An examination of the medical administration record showed only one dose was actually used. The provider refunded $52,745 in incorrect charges.

  • An endoscopic procedure charge included a cost for the purchase of the instrument. The reusable instrument cost $2300 and is not a billable charge. It was removed from the bill.

  • Following a mastectomy, a plastic surgeon had billed for reconstructing three breasts. The erroneous charges were removed, as well as a home-health aid that was not a plan benefit.


 
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