Case Study: Taking the Pain Out of a Medical Claims Mix-Ups

3-minute read

THE CHALLENGE: Medical claims snafus are always a nuisance. Sometimes, however, they can end up costing everyone plenty. Such was the situation facing one of our clients. It found itself with more than $220,000 in medical bills for one of its police officers, a man who contracted Covid from a co-worker in late 2021 and, sadly, died after about three weeks in the hospital. That wasn’t the only cost. The client’s health plan was coming up for renewal soon and, because of the medical claim, was expected to reflect much higher premiums than it was paying at the time.


OUR SOLUTION: Once aware of the situation, our advisor and claims management team quickly ascertained the claim in the officer’s death was being handled by the wrong insurer. Although the officer’s wife had supplied the hospital with the family’s health insurance policy number, it was the client’s workers’ compensation insurer – which was already paying her widow benefits – that should have been covering the medical bills. Problem was, no one had sent it a single bill. Straightening that mix-up was straight-forward. Getting it to reimburse the health insurance company for its outlay was a different matter.

THE OUTCOME: Relationships, as we all know, can make a huge difference in business. In this case, thanks to our longstanding relationship with the workers’ comp carrier’s claims manager, our own claims people were able to persuade the carrier to write a check to the health insurer rather than go through a review that could easily have stretched on for months. As a result, a check was in the mail within two weeks of our involvement, saving the client money and, as it happened, saving the workers’ comp carrier money that it would have been forced to spend were it dealing with a brokerage it didn’t know and trust.

The Mahoney Group, based in Mesa, Ariz., is one of the largest independent insurance and employee benefits brokerages in the U.S. An employee-owned organization, we’ve been providing our clients with the confidence to face whatever lies ahead for more than 100 years. For more information, contact us online or call 877-440-3304.

This article is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.

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