Case Study
A Self-Funded Plan incurred a high-dollar medical bill, even after an in-network discount of 28%, for treating bacterial and tuberculous infections of a woman’s nervous system.
Find Out How
We did it
Kansas, US
Kansas, US
Overview
A confused 20-year-old female was found on the floor by family, prompting a visit to the Emergency Room. The patient reported falling out of bed hours earlier, unable to move her lower extremities or bend her knees.
Additionally, she noted recent gastrointestinal symptoms and visual floaters over the prior weeks. She had a family history of neurologic diseases.
Due to concerning symptoms for suspected Guillain-Barré Syndrome, the patient was admitted to an acute care facility in New Mexico and Intravenous Immunoglobulin treatment (IVIG) was initiated immediately for seven days.
WHAT DID WE
DO ABOUT IT?
What we did about it
After a thorough case review, our Complex Claims Unit (CCU) concluded that the principal diagnosis of Guillain-Barré Syndrome (GBS) was not warranted and did not accurately reflect the patient’s status at the time of discharge.
The CCU legal escalation process was initiated, negotiating on the basis that the patient was overtreated with IVIG infusions prior to Cerebrospinal Fluid leak (CSF) testing for confirmation of her condition. CSF results later confirmed her condition was not suggestive of GBS. This resulted in otherwise avoidable charges for IVIG infusions.
We presented our findings to the provider, who agreed to a further reduction in billed charges.
WANT TO KNOW
The Results?
Results
Total initial charges
Final charges, secured by Global Excel
Total Savings:
Client Savings
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