Corrected Hospital Billing Error Saves Patient $150,000

The Client

Furniture Retailer with over one hundred enrolled employees

The Challenge

An employee’s spouse was diagnosed with COVID-19 and hospitalized for over 45 days. As the patient’s health improved, the hospital filled up, so the employee’s family worked with administrators and staff to transfer the them to a new facility.  This facility was out-of-network, but a GAPP exception was granted – allowing the patient to stay at any hospital within a 75-mile radius at in-network rates.

When the patient safely returned home and received their bill, they were shocked to see the amount they were charged. The GAPP exception was not included in their explanation of benefits, making the family responsible for all out-of-network rates that should have been waived.

The Solution

A Caravus Client Advocate and Strategic Advisor reached out to the carrier and explained the circumstances of the situation. They were able to work with the carrier to enforce the GAPP extension, and corrected the billing mistake.

The Outcome

After the billing mistake was corrected, the employee and their family saw a total savings of over $150,000.