Success Stories

Putting Money Back in Your Pockets

Family assisted in filing claim with insuranceKevin’s wife, Brooke contacted The Purple Card® for assistance with filing claims for their Flexible Spending Account (FSA) and Health care Reimbursement Account (HRA) plans.

Their Patient Advocate at The Purple Card® gathered all of the Explanation of Benefits (EOBs) through the insurance carrier’s website, completed the claim forms, and submitted all of the documents for reimbursement. The Purple Card® saved this family time and money by filing their FSA and HRA claims for a total reimbursement of $1,625.24!

The happy spouse shared the following comment about her experience with The Purple Card®:

“Thanks so much. I really do appreciate all that you do to make the benefits at my husband’s employer easier for their employees!”

Reading Between The Lines

Senior couple on cycle rideCheryl fell and broke her back while riding a horse. She was transported in an ambulance to the nearest hospital only to discover it was not equipped to treat the level of her injuries.

She was transported a second time in an ambulance to another facility that could treat her. The claim for the second ambulance ride was denied as a non-covered benefit on their plan.

The Patient Advocate reviewed the entire plan document for language that would allow coverage for emergency transportation.

The Patient Advocate appealed the denied claim using the exact language included in the plan document, and won.

The insurance carrier overturned the initial denial and sent a full payment of $27,244.71 to the ambulance provider. Cheryl’s Patient Advocate saved her $27,244.71!

The HR Director at her company responded with the following comment:

“Well, I think our Patient Advocate does a GREAT job every day, but this was incredible!”

 

Advocating for What’s Right

Asian woman with puppy.Amy had a surgical procedure and received a balance bill of $1,068 from the radiologist.

She called The Purple Card® for assistance. The Patient Advocate contacted the insurance carrier and found out the provider filed the same claim three times.

The claim had been processed and paid correctly by the insurance carrier according to the insurance contract. Per the contract, the provider should not have billed Amy the balance because of providers coding practice. Once notified of the balance bill, the insurance carrier mailed a letter to the provider advising them to stop billing Amy for the $1,068 balance because was not responsible for this amount.

Amy responded:

“Thank you! I really appreciate the time and effort you took looking into this!”

Biting Back!

casestudies_markanddannyMark’s son, Danny was playing in the yard and was bit by a neighbor’s dog. Mark took him to an urgent care facility for treatment. During check‐in, Mark paid a $65 co‐pay.

Later, he received a bill for an additional $290.24 for wound closure. The insurance carrier had already processed the claim and applied this amount towards the plan deductible, making it Mark’s responsibility. Mark disagreed with the charge and called The Purple Card® for assistance. Mark told the Patient Advocate the urgent care facility cleaned the wound, but left it open and uncovered. He explained that his son, Danny didn’t receive any stitches, bandages, or gauze – not even a Band-Aid.

The Patient Advocate immediately called the urgent care billing office and requested a line-by-line review of the charges. The billing office reviewed the doctor’s medical records and determined the charges needed to be removed.

Mark responded:

“Thanks so much!“

Claims Audit Yields Savings

casestudies_frank_2Frank received several expensive bills for his wife’s hospital stay. He was concerned about being overcharged and requested assistance from his Purple Card Patient Advocate. The Patient Advocate collected copies of the bills and explanation of benefits to perform a claim audit.

Upon completion of the audit, the Patient Advocate found all of the claims had not been processed correctly. She contacted the carrier on Frank’s behalf and had the provider reprocess the claims. Once the claims were reprocessed, the Patient Advocate saved Frank and his wife $2,051.

He was extremely pleased and responded:

“Thanks so much. I really appreciate all that you and the Purple Card have done for us! “

Education for Negotiation

rsz_case_studies_myaMya, suffering from nausea, vomiting and abdominal pain was rushed to the emergency room for food poisoning. She was surprised when she received a very high bill, and was extremely concerned whether the charges were correct. Mya also wanted to know if there was any way to negotiate a reduction for the amount owed. The Patient Advocate at The Purple Card® worked with Mya and verified the charges were correct, then offered several strategies for Mya to negotiate a lower amount with the provider.

Mya was extremely pleased with the outcome and stated:

“I wanted you to know how impressed I was by The Purple Card® and their level of service. My Patient Advocate went above and beyond the call of duty. I very much appreciated the education and savings she provided! “