Advocacy in Action | Preventative vs. Diagnostic Claims

A member contacted her Patient Advocate to find out why she was being billed $753.00 for her routine preventative colonoscopy. This was the first time she had ever had a colonoscopy and her doctor told her it was a preventative test. She told her Patient Advocate she had just lost her mother and she really could not afford to pay the bill. Her Patient Advocate researched the bill and found out the gastroenterologist’s office submitted the claim to the insurance company as a diagnostic procedure and not as a routine preventative procedure. The Patient Adocate worked with the billing office and the doctor to get the claim coded correctly and reprocessed by the insurance company. Once all was said and done, the plan paid the claim at 100% and the member owed nothing. The member saved $753.00 and was extremely appreciative. She shared these words of praise:

“I just don’t know what I would do without your help. You are always there for me. Thank you so very, very much!”

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At Brinson Benefits, we care about the patient’s best interest. We believe the patient should have an available healthcare navigator and advocate. Our Patient Advocates at The Purple Card® are highly trained to educate members about available benefit programs. They work hard to resolve issues with providers and insurers.

The Purple Card® is an independent health care advocacy and assistance service. Our Patient Advocates provide time and cost-saving services to resolve concerns about benefit programs. We not only assist our members, we educate them on ways to maximize health care coverage and other available benefit programs.