CASE STUDY: COORDINATION OF BENEFITS PROBLEMS

CASE STUDY: COORDINATION OF BENEFITS PROBLEMS

Situation A 36 year old woman required extensive services from her obstetrician during her high-risk pregnancy. These services involved a number of ultrasounds throughout her pregnancy to monitor the growth of the fetus. After a healthy baby was born, the woman began...
EMERGENCY DELIVERY CAN HAVE ITS COSTS

EMERGENCY DELIVERY CAN HAVE ITS COSTS

SITUATION A 32 year old woman was pregnant.  She had insurance coverage through her husband’s employer.  She received all of her prenatal care through in-network doctors and facilities.  All of the prenatal claims were submitted to her husband’s insurance and paid by...
STUDY MEDICAL BILLS CAREFULLY…80% HAVE ERRORS

STUDY MEDICAL BILLS CAREFULLY…80% HAVE ERRORS

SITUATION A 25 year-old female with persistent nasal congestion, sinus pressure, and sore throat that had not responded to numerous treatments prescribed by her primary care doctor PATIENT PROCESS In a phone call to her doctor, the patient was instructed to return to...
BE SURE TO WAIT FOR AUTHORIZATIONS

BE SURE TO WAIT FOR AUTHORIZATIONS

Situation A 23 year old woman suffered from a variety of symptoms, including extreme fatigue, dizziness, and joint pain, symptoms that increased in type and frequency and grew to include headaches, memory loss, difficulties concentrating, hair loss, facial and...
ARE ALL YEARLY WELL VISITS TRULY FREE?

ARE ALL YEARLY WELL VISITS TRULY FREE?

Situation A 30 year-old male wanted to schedule a yearly physical/well visit with his primary care doctor.  He assumed that this visit and all procedures associated with it should be fully covered and paid by his insurance company without any out-of-pocket cost to...
WHAT TO DO WHEN TREATMENTS ARE DENIED

WHAT TO DO WHEN TREATMENTS ARE DENIED

CASE STUDY: DENIED INFUSION TREATMENT Situation A 47 year old man suffering from rheumatoid arthritis for more than 15 years, was denied authorization by his new insurance company for an infusion therapy that had been authorized by a previous insurer, and from which...