Reading Between The Lines
Cheryl 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!”