Lost Benjamins Award: January 2022 Nominee for Most Absurd Healthcare Claim
Man Glows After Hundreds of X-Rays on Same Day
No, this didn’t really happen. But absurd healthcare claims appear almost everywhere. If this absurd healthcare claim was actually true, this patient would have been out thousands of dollars and been exposed to an extremely unhealthy level of radiation.
Financial Consequences
Imagine receiving a hospital bill for $58,000 for x-rays all performed on your knee. Well, that’s the surprise invoice a patient received after a recent trip to the radiology department! This patient needed an x-ray of his knee, but he did not need 850 x-rays on his same knee on the same day! These 850 procedures were billed at a cost of more than $58,000!
Physical Consequences
Obviously, this is a billing error that is non-sensical. However, consider the physical consequences for our patient if all these x-rays had occurred. According to the National Council on Radiation Protection and Measurement, the average amount of radiation from an x-ray on limbs and joints is 0.06 mSv (6 mrem). In comparison, the average annual radiation dose from natural background sources such as radon in your home is 3.0 mSv (300 mrem).
To put this claim in perspective, if the patient really received this many x-rays in one day, he would have been exposed to more than 51 mSv (5,100 mrem) of radiation which is 1,700 times more than the average annual radon radiation. His leg would not have survived all of this radiation!
Healthcare Claims Audits Protect Companies & Employees
Large self-funded companies hire TPAs to process thousands of healthcare claims on their behalf. Mistakes happen. Sometimes the errors are a one-time event. Other times there is a systemic issue that causes the same error to occur over and over. Comprehensive audits evaluate your paid medical claims and identify errors. You have to find the errors before you can recover the dollars!
Finding errors benefits companies by:
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- returning dollars back to the company’s bottom line
- holding increasing premiums in check
- allowing better plan options as an employee benefit
Finding errors benefits employees by:
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- identifying excessive out-of-pocket expenses and returning overpayments
- protecting any lifetime maximum payout that may be in place
Do you have an example of a Healthcare Claim Absurdity?
We know our audits catch a lot of inaccurate claims. Fortunately, seeing ones that defy the imagination are rare. However, there are many, many overpayments costing patients and companies thousands of dollars. We want to hear your best example! Who knows? We may feature your story as one of our monthly nominees! Send your best story to hhadmin@healthcarehorizons.com with the Subject Line: Lost Benjamins Award. If we use yours, we’ll be sure to give you the recognition you deserve for shining a light on medical overpayments!