An employee of an Emry client experienced a mental health episode and was taken by ambulance to a local hospital emergency room. The member was later admitted to the hospital for services over 3 days. Emergency room was covered but hospital was out-of-network and billed $35,400 for services.
The Emry bill review determined that the hospital processed an internal pre-authorization for inpatient services and transferred the member. With billing advocate intervention, it was demonstrated that the member was not of sound mind and gave no approval for the transfer.
Emry ensured that the bill was reprocessed as in-network subject to remaining in-network deductible and coinsurance, saving member $33,000.