Member Aggravation: Employee called BenefitsVIP requesting assistance with a medical claim indicating he was responsible to pay a provider $11,000.  Employee was extremely upset as he had received the approval for the procedure in advance.

BenefitsVIP Intervention: BenefitsVIP immediately called the carrier and reviewed the processing of the claim with the account manager. It was found that the claim was paid out of network because the employee had been activated under the incorrect group number. Further review showed that several others at the same company were in the wrong group. BenefitsVIP assisted with an eligibility and subsequent claims audit.

Resolution: All employees were put in the correct group number. All outstanding claims were reprocessed and paid correctly.  The $11,000 claim was paid with no member liability.

Client Response: “You just made my week-end. I was trying to figure out a way to tell my wife we have a bill for $11K. Thank you very much!

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