The DOC

April 2021 | Get the latest from the best RBP advocates and auditors 

Industry Perspectives

Amy Howells, J.D.

Associate Counsel

No Surprises Act 1

In a bipartisan effort to end balance billing, the No Surprises Act was written into the most recent coronavirus relief package. “Balance bills” are bills that are often received by patients from medical providers who are not part of their insurance network. The amounts of these balance bills reflect the difference between what the provider bills and what insurance pays. The patient ends up stuck owing the amount that is not covered by insurance. These bills can be extremely high and come as a surprise to the patient who often doesn’t know the provider is out of network or didn’t have a choice of provider in the first place, such as in the case of emergency services.

The No Surprises Act seeks to eliminate balance bills in three primary circumstances: emergency services from out-of-network providers, air ambulance services, and nonemergency services at an in-network facility billed by an out-of-network provider. Unlike state balance bill laws with a similar purpose, the No Surprises Act applies to a broader range of insurance plans, including self-funded plans like those serviced by ClaimDOC. Read More...

Client Savings

Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.

1. Nashville, TN

Hospital outpatient services for the treatment of uterovaginal prolapse and related surgery

High-Dollar Services:

Operating Room: $45,274.02
Recovery Room: $14,859
Anesthesia: $10,280

Savings Summary:

Billed Charges: $78,849.45
ClaimDOC Allowed: $12,947.56
Plan Savings: $65,901.89
Reduction: 84%

2. Atlanta, GA

Nine-day hospital stay for the treatment of spleen laceration and fractures of foot and toes

High-Dollar Services:

Operating Room: $76,152
Room and Board: $39,108
CT Scans: $37,025
Radiology: $18,586

Savings Summary:

Billed Charges: $228,930.27
ClaimDOC Allowed: $46,902.38
Plan Savings: $182,027.89
Reduction: 80%

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

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