HIGH-COST HERNIA REPAIR

CHALLENGE

  • $189,000 for facility and surgeon charges
  • Provider was OON
  • Charges were paid at 100%

SOLUTION

  • Provided price benchmarking data
  • Identified inconsistent payment methodologies applied to this provider
  • Referral of claims to SID for investigation

CLIENT WIN

  • SID investigation discovered that a non-covered service (bariatric surgery) was billed as a hernia repair

Plan Recovery of
$134,645