Last month, I shared a story about a woman, who had medical bills that had to be negotiated, totaling close to a million dollars and the bills were paid in full to the hospital from her insurance company. Now, I will tell a story of a woman, who had medical bills over $500,000, from out-of-state care. Between the 2 cases, with very different facts and billing complications, MedWise Insurance Advocacy saved 2 clients over 1.5 million dollars in less than a year. Let’s look at the facts and see how MedWise Advocacy made those bills disappear.
A women needed back surgery. She had reached her deductible and traveled 4 states away to get the best care for her surgery. The woman had ACA insurance through her state of residency. The insurance company originally agreed to cover and pay her needed for out-of-state care and authorized her to travel 4 states away to receive such care. She went, had the surgery in Dec. 2015 and then she started to receive bills from the providers for over $500,000.
The hospital bill alone was $188,000. They were paid $54,000 by the out-of-state insurance and with the help of MedWise Insurance Advocacy the hospital wrote off the difference. The primary surgeon bill was $166,000 and was only paid approx. $50,000. Again, with the assistance of MedWise the doctor wrote off the difference.
I do not know what was paid by the insurance for the assistant surgeon’s $133,000 bill but the entire bill was written off because of MedWise’s negotiations. There were additional bills from multiple providers who saw her in the hospital, totaling the bill over $500,000. MedWise was able to get the hospital and medical providers to write off the entire difference so the patient did not have to pay for them after receiving preauthorized out-of-state surgery.
The client still needed additional surgery about 13 months later and the hospital, which was 4 states away decided to forewarn her of what her co-pays would be. The cost was so high that she contacted the prior out-of-state surgeon, who recommended her an experienced surgeon in-state. After hearing about the insurance debacle. the doctor changed referrals to providers in-state and all of the patients bills were then covered in-state. Staying in state when receiving medical care can greatly reduce medical bills.
It is important that patients realize that medical care coverage is not only a contract between them and their insurance company or them and the hospital. Medical care coverage truly involves multiple contracts, one between a patient and the medical facility, one between the patient and each doctor, one between the patient and the insurance company and multiple contracts between the insurance company, doctors and medical facilities. I am glad to help my clients understand the complexities of these contracts and get the parties motivated to work together for mutual benefit. It is truly a gift to provide relief to patients who are suffering from stress because of medical bills, it is important to have an advocate that gets results.