DENIAL OF AIR TRANSPORTATION

CHALLENGE

  • Denial by TPA for air transport to promptly treat a new onset of seizures
  • ER physician did not completely fill out Medical Necessity Form
  • Out-of-network charges were in excess of $67,000
  • Patient billed and was 30 days from being sent to collections

SOLUTION

  • Contacted hospital and requested that physician amend Medical Necessity Form
  • Lockton Medical Director provided an independent opinion at the claim administrator’s request
  • OON negotiations completed and denial was overturned

CLIENT WIN

  • Member was spared $67,000 of unexpected debt and plan discount obtained

Health Plan Savings of
$13,414

Member Savings of
$67,071