The USBenefits claim department has, on average, over 35 years of experience in claim payment and review. Your goal is our goal – to provide the best possible outcome for the employer. This knowledge base, along with a team of the top cost containment vendors in the business, gives us the ability to control claim costs for our clients.
Below is a recent success story achieved by our claims team.
A teenaged girl burns her foot in the shower which results in a 10-day inpatient stay with billed charges over 600K. The claim was sent to a vendor and it was determined that the mark up on the skin grafts were 10 times the cost. Once the vendor made the provider aware of the mark up, the provider sent in a corrected bill which reduced the charges by 300K.
Since 300K for a burned foot still seemed excessive, the vendor had a burn specialist review the claim and it was determined that skin grafts were not the appropriate treatment. The vendor sent the provider a detailed report summarizing their findings and discussed the report with the provider. The provider stated they would review the vendor report, and respond. No response was received.
After discussions between USBenefits (USB) claim staff and the vendor, it was determined that the best course of action would be to pay the provider 76k to cover their costs for the 10-day hospital stay. The TPA agree to reimburse the provider 76K. Total savings after the PPO discount is $300,945.33. Does your stop-loss partner go above and beyond to save you money?