Employee Receives $1,000 Reimbursement for Carrier Claims Mistake

The Client

Financial Institution with over 80 enrolled employees

The Challenge

A client’s employee ordered a CPAP machine from a provider that was listed by their carrier as in-network, but later found out that only a certain division of that provider was in-network. This resulted in an out-of-network claim, and a large out-of-pocket charge to the employee.

The Solution

After contacting their Caravus Advocate for help, the advocacy team contacted the carrier on the employee’s behalf. The team pointed out the misguiding language listed on the member portal that led to the employee’s confusion, and discussed the misinformation provided by the carrier to the employee that led to the out-of-network purchase of the medical equipment.

The Outcome

Caravus received approval from upper management at the carrier to have the claim processed as in-network, and the member received a reimbursement for over $1,000 – covering all their expenses previously paid out-of-pocket.