We are about five times the size we were in 2019 and we have only gotten better. We give clients a high-end boutique feel where client and member service is prioritized over everything.
July 2024 | Get the latest from the best RBP advocates and auditors
Industry Perspective
Bruce Hansen
Executive Vice President
Midyear Business Update
Around 2019, a broker in Georgia told us he wasn’t interested in telling anyone about how well we’d performed for his clients because he didn’t think we could execute our unique solution if we got bigger. He was wrong. We are about five times the size we were in 2019 and we have only gotten better. I understand the concern though. We give clients a high-end boutique feel where client and member service is prioritized over everything. We aren’t the most expensive RBP vendor, but we offer the most premium services where they matter. The level of attention and responsiveness brokers and their clients get from our staff isn’t something one would expect from a large player. I want to share with our partners what this growth looks like and reinforce our commitment to executing at the level they expect. Read more...
Audit Spotlight
Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA
Senior Audit Manager
Red Flags — Egregious Anesthesia Charges Billed to Member
In this Claims Audit Spotlight, we focus on recent claims where a ClaimDOC auditor raised red flags and asked the same question on both claims — are the anesthesiologist and CRNA really charging this much for their anesthesia services or is this a billing error?
Case 1
A 28-year-old plan member was seen for low back pain and received a percutaneous image-guided injection performed in an ambulatory surgical center (ASC) in Dallas, Texas. Read more...
DirectAccess+ Savings
DirectAccess+™ clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. The audit team performs line-by-line claim audits to help clients and members maximize their savings. Below is one recent audit result showcasing substantial savings.
1. Danville, Virginia
Hospital outpatient services for the treatment of multiple myeloma and chemotherapy
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback from a Member
"I'm relieved that my member advocate, Victoria, was with me as we transitioned to our new ClaimDOC medical plan. She cleared the path for me, which made my appointments very routine.
Thank you, Victoria!"
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