Caravus Advocates Help Member Avoid $125K Surgery Bill

The Client 

Company operating in the freight and logistics company with 81 enrolled employees (103 full-time benefit eligible employees).

The Challenge 

A member had a $125,681 claim for a heart defibrillator and pacemaker surgery that was denied, making the member responsible for the full claim amount.

The Solution 

The Caravus Advocacy team asked the insurance carrier why the claim was denied and worked with their contacts at the carrier to collect the information needed to overturn the claim denial.

The Outcome 

Once the team submitted the additional information, the member’s claim was reprocessed and approved by the insurance carrier. This claim then processed towards the members deductible and out of pocket maximum, bringing their total responsibility down to only $5,961.80 – a near $120,000 difference!