A MedBen Client received a $160,109 claim for an out-of-network back surgery. After the claim was repriced, the unusually high cost for this procedure was flagged by our claims surveillance. Due to this, a MedBen-contracted orthopedic specialist reviewed the claim and negotiated additional savings from the provider.
Through claims review and negotiation, the Client saved an additional $57,918.
This case study shows one reason why you should never rely on auto-adjudication alone – it doesn’t work for the Client. MedBen uses a physician-directed approach to work targeted claims representing a variety of specialties. On average, they save an additional 51% over and above the PPO discount.
MedBen forensic claim reviews ensure that you pay the right price for necessary care. Call us today at 888-627-8683 to learn more.