The DOC

January 2023 | Get the latest from the best RBP advocates and auditors 

Industry Perspective

Ben Krambeck

CEO

Looking Back: 10th Anniversary

I’m going to deviate from our typical Industry Perspective and get personal by sharing more details about our company and myself than I'm typically comfortable doing. January marks our 10th anniversary, and the achievement has struck me differently than I expected. I rarely stop to reflect on what we’ve accomplished. I have never been satisfied with my work, and I’ve surrounded myself with leaders at ClaimDOC who operate with this same drive to demand more and be better. It’s time to be proud of what we have done and share our story.

Anyone that has built a business from nothing and with nothing will understand how complex my life has been over the last 10 years. It all started when a captive program I had with partners was decimated in 2012 by high-cost claimants. Through hands-on bill review work, I saw firsthand the abuses in the billing and flaws in network contracts. I then learned RBP solutions didn’t adequately take care of members. This is when and why I started ClaimDOC as a full-service network replacement option for plan sponsors.

Like many people willing to risk their family’s financial future to start a business, I admit I have a unique and probably challenging personality. Externally people will see success, but what they don’t see are the times when you almost break mentally and financially. Like many flawed people, this has sometimes brought out the worst in me, creating a line of people who deserve an apology. I’m very lucky my leadership team at ClaimDOC is willing to hold me accountable, show me compassion, and push me to be better. Two executives, Amy Pellegrin and Bruce Hansen, joined me in 2016. Not only have they been the key to my company turning the corner, more importantly, they have cared about me as a person. Beyond friendship, we’ve shared a vision to not make this about our personal finances and instead drive investment into our people and solution to quietly build ourselves into a powerhouse. Read more...

Audit Spotlight

Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA

Senior Audit Manager

The Shocking Cost of Air Ambulance Services

In this Claims Audit Spotlight, we focus on air ambulance services and their related charges which in most instances are considered “shocking.”

According to Air Ambulance NPRM – Fact Sheet, September 10, 2021, “Air ambulance services frequently result in surprise medical bills due to individuals’ inability to select an in-network provider when faced with an urgent medical situation. A 2019 study by the Government Accountability Office (GAO) found that 69 percent of air ambulance transports of privately insured patients were out-of-network in 2017 and that for privately insured patients, the median price charged by providers of air ambulance services was $36,400 for helicopter transport and $40,600 for a fixed-wing transport in 2017.” 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. St. Louis, MO

Physician office services for chemotherapy treatment due to malignant melanoma

High-Dollar Services:

• Chemo IV Infusion: $566

Savings Summary:

Billed Charges: $82,732
ClaimDOC Allowed: $170.94
Plan Savings: $82,561.06
Reduction: 99%

2. Spring Valley, IL

Outpatient clinic dialysis treatments (3) for the treatment of acute kidney failure

High-Dollar Services:

Dialysis Treatments (3): $85,273.94

Savings Summary:

Billed Charges: $85,273.94
ClaimDOC Allowed: $1,275.23
Plan Savings: $83,998.71
Reduction: 99%

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

Levi worked diligently with a challenging provider to get them comfortable with the plan. This provider is top of the food chain for kids with learning and mental health challenges. School systems accept their diagnoses and implement their recommendations in school. Levi took the time to effectively explain what ClaimDOC does. The provider now submits claims without any issues. He works quietly behind the scenes and then shows up with the win.Thank you, Levi!
 

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