Case Study: Trip Interrupted

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May 24th, 2012
Categories: Case Studies

A woman from the UK celebrating her 50th wedding anniversary took a cruise with her husband along the coast of Mexico and became ill during her trip. Her insurance company chose to expatriate her back to the UK for care. Unfortunately, as she was departing, she became very ill at the airport in Acapulco, Mexico and could not travel. She was hospitalized locally and rushed into emergency surgery.

PayerFusion TPA servicesAt $80,000 USD, we found the costs associated with her case at about 3 times the amount that is customary for her condition and required treatment, compared to like facilities. Our examination of the charges revealed unnecessary services and some inaccurate or inappropriate charges. For example, her bill included an around-the-clock doctor and nurse, which she did not receive, charges for medical scrubs, as well as fees to pay doctors to observe her surgery. To make matters worse, without full payment, the facility threatened to keep the patient at the hospital, forcing a British diplomat in the area to personally escort the patient out of the hospital.

PayerFusion activated the services of its physician case managers in Mexico who are trained in the Mexican insurance industry. They successfully managed the care for our client. An agreement was reached with the hospital about which charges were fair and reasonable and what was the appropriate treatment for her case. This resulted is a clean claim that fairly compensated the hospital for services rendered while producing a reduction of the patient’s billed charges that exceeded 40%.

Having to find a reputable healthcare provider when you’re far from home is daunting, particularly in an emergency. PayerFusion can help you and your patients avoid situations like the one described here. We also employ our case management services to ensure that patients receive the appropriate care while helping to proactively contain the cost of medical care on behalf of the insurer. If you would like more information about our network of high-quality, international providers and our services for travel insurance/assistance companies please Contact Us.