We originally received this member’s claim on 11/25/13. The primary carrier left the member’s balance at $7,000 which was much higher than her out of pocket maximum. This amount was questioned by the group, which prompted the Service team to contact primary to explain their process of the claim.
When we spoke with the primary carrier they could not explain why this claim was processed the way it was. They are going to review and reprocess all of her 2013 claims so there may be some additional refunds. So far we at least saved the group $7,000 on the one claim, but may have saved them even more once the primary carrier has reprocessed their claims.
Going above and beyond in our Client Services by researching claims and contacting primary, we were able to determine primary’s processing error and save the client and the member on their out of pocket expenses.
At ClaimLinx, this is just another example of how we save our clients and members money.
If you have questions about a claim or need additional information, please email firstname.lastname@example.org. We would be happy to help.