Who Fights for Your Claims?

Participants with medical insurance receive care from their provider who then submits claims to the insurance carrier.

Have you ever wondered what happens from there? Well, once the carrier receives the claim, their claims team interprets the claim and reviews it relative to the plan document for that particular medical plan. Then they either pay the claim, decline the claim, or ask for further information. Clients don’t realize how many mistakes are committed by the various parties involved in that claim. Who will advocate for your claims to be paid in order for you to get the MOST out of your medical insurance that you pay so much for?

Engineering Firm in New York

Team work and together concept, Hand of people high five for tag team

This employer utilizes one of the largest national health insurance carriers under their premier plans. With 150 employees and millions of premium dollars per year, they expect the best of the best when it comes to service. Several employees complained about receiving medical bills they did not feel were justified. After receiving EoB’s directly from the carrier, they were saddened to see that it appeared the charges were correct. Not so fast! After forwarding these EoB’s over to ClearscopeHR, we acted as an advocate for all of these claims, re-escalating these claims up to claim review boards and actually uncovering an error in the carrier’s own internal claims system. Use ClearscopeHR as a resource to go to bat for you and your employees!



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