HR reached out because they had a pregnant member who was being denied her short term disability. Miranda was a new hire whose new hire benefits and open enrollment ran very close together. Miranda did not elect her coverage during her new hire period and instead elected during open enrollment. This made it where she would have to fill out an evidence of insurability (EOI) form. Miranda’s short term disability benefit for her pregnancy was denied due to this form and lack of understanding of the policy. This means, she would have no income during her maternity leave. Imagine being pregnant or having a newborn and not being sure how to afford items like food, diapers, formula…a home!
Naturally, Miranda was stressing over her impending financial situation (which is never good for a pregnancy) and in turn was causing a great deal of anxiety for HR. They then remembered they had The Purple Card and got in touch with their advocate. After much back and forth with the carrier, the advocate was able to move mountains and get Miranda’s short term disability approved for her pregnancy…without the EOI! This was needless to say, a huge win and relief!
She definitely has a Guardian Angel whose name is BRINSON!… God Bless You for your above and beyond on this case!
Ingrid needed help. Her child needed to be evaluated by a neuropsychologist. Ingrid did not fully understand her benefits and was looking at using an out of network provider—oh no! After her conversation with a patient advocate, she understood the benefit (insurance and financial) of using an in network provider and found out how she can use the HRA that her employer offered! The advocate provided her with a list of in network providers who were accepting new patients and let her know that the procedure codes that she was looking at using required no authorization. The member was thrilled! Just see what Ingrid had to say:
Thank you for going above and beyond my expectations. I really do appreciate your help. This is a curvy road as it is. Thanks for helping me navigate.
An ambulance company balance billed the member for $1,787.87. The member did not understand why so they contacted their Patient Advocate for assistance. The Patient Advocate went to work to see how she could help. When checking the insurance plan and benefits, the Patient Advocate learned the ambulance service used was an in‐network service provider. The Patient Advocate also found the member had met both her deductible and her out-of-pocket maximum and should not owe anything on the bill. After checking the claim payment and auditing the bill, the Patient Advocate was able to determine the company incorrectly balance billed the member. The ambulance company was contacted and advised they were an in‐network service provider and should not be balance billing the member. They denied being an in‐network service provider and did not believe anything the Patient Advocate was saying. The Patient Advocate faxed over a copy of the claims Explanation of Benefits showing the service provider to be in‐network, along with a copy of the web directory from the carrier website which also showed the provider to be in‐network. The service provider still refused to acknowledge they were an in‐network service provider and would not adjust the bill. The Patient Advocate then reached out to the insurance carrier and explained the situation. The claims manager immediately contacted the Director of Network Access who in turn contacted the service provider to confirm they were an in‐network service provider. The Director of Network Access explained to the ambulance company they had contractual obligations to the insurance carrier, and they should immediately cease their balance billing efforts. The conversation did the trick, and the member’s account was adjusted to a zero balance saving the member over $1,700.
Juan had gone in for an echocardiogram. Almost everything turned out fine…everything but the billing! Juan was not expecting to get a bill that was over $2,500! He contacted his dedicated Patient Advocate and they got on the case. In the end, all that Juan owed was less than the cost of getting a drip coffee!
“I did receive a new invoice and it was for only $1.08 so THANK YOU!!!! I greatly appreciate your help with this!!”
A member contacted The Purple Card® because she received an anesthesia bill showing she was being balanced billed for $900. The member sent a copy of the bill to her Patient Advocate because she wanted to understand why the provider was sending her a bill. The procedure had been pre-authorized and the facility she used was an in-network facility. The Patient Advocate checked and found out the anesthesiologist was not an in-network provider and because he was not contracted with the carrier he had a right to balance bill the patient. The Patient Advocate filed an appeal with the insurance carrier stating the procedure was pre-authorized and the member used an in-network facility. The insurance carrier reviewed the matter and agreed to pay the out-of-network balance billed amount to the service provider. Once the additional payment was processed and sent to the provider, the member had no patient responsibility and owed the provider nothing. Here is what the member had to say about the services received from The Purple Card®:
“Oh my gosh you are wonderful!!! THANK YOU, THANK YOU, THANK YOU for your prompt response and saving the day!!!”
Maria got a bill that was not expected…over $300 not expected! She checked her accounts and could not find anything showing that her insurance processed that service. To make matters worse, the provider notified her that her coverage had terminated!
The Purple Card to the rescue! Her dedicated Patient Advocate got in touch with her provider. This caused the bill to be reprocessed and stopped the billing attempts till resolved. Maria was quite relieved that she was not going to have to pay over $300!
You are so super awesome! And you will never know just how much I appreciate everything you do for me!
A member was being billed for various dates of service and she knew that it was not right so she reached out to her Patient Advocate. Her advocate started reaching out to the carrier and facility and was able to get her member responsibility down to $0! See what this member had to say:
All I can say is THANK YOU SO MUCH! You have been there for me again. I really appreciate the way you take charge and fight these unreasonable battles for us. You saved me money, headache and time! If there is anything I can do for you do not hesitate to let me know. You are a true Servant in Christ.
A member knew that something wasn’t right with how her dentist was billing. She thought she was due a refund but her provider would not give it to her and she needed help…Purple Card help! Her patient advocate reviewed her bills, her explanation of benefits and stayed in communication with her provider. After over a month of hard work, The Purple Card was able to secure a refund of over $2,200! This was a major win for the member!
THANK YOU!!! I can’t believe I almost just got tired of arguing with them and let this go. I wouldn’t have pursued it, had I not went to our benefit meeting this past fall. You are awesome! Thank you so much!!!!
One member was in a bind. He had an enrollment issue and was not showing active with insurance. To add to the situation, he needed an ID card and a list of COVID-19 testing sites. He contacted The Purple card and in just over an hour, he had active coverage, an ID card and a list of locations to get tested. He was extremely grateful. Just see what he had to say:
I wanted to say thank you…man you got the ball rolling and that really helped out. You’re a hero in my book.
One member reached out to The Purple Card with an issue about her MRI. It was denied and she was potentially liable for over $6,500. Her Patient Advocate started working her purple magic! After reaching out to the doctor and the insurance company multiple times, the appeal was approved and the member no longer had to worry. Just see what she had to say:
That is AMAZING news. Thank you!! Thank you SO much for your help. That bill was really starting to worry me.