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"The Case of the Overpriced Robot"

01/25/19

  01:30:00 pm, by MedBen5   , 181 words,  
Categories: Cost savings, Claims management, Reference-based pricing

"The Case of the Overpriced Robot"

robotic surgery

MedBen claims management uses multiple measures to ensure that your plan pays the proper price for health care services, but at the core is our team of experienced claim examiners.

To cite one example, a plan member of a MedBen client underwent robotic hernia repair for a ventral hernia. The client was billed $310,000 for 15-minute usage of robotics – over 10 times the usual allowed amount for robotic surgery.

As part of MedBen’s claims evaluation process, an examiner reviewed the claim, noted the excessive billed amount, and paid it in accordance with the client reference-based pricing (RBP) plan language. Based on the RBP formula of a standard Medicare payment for the surgery plus a set added percentage, the provider received $60,000.

The client saved $250,000 on the billed charge for robotic hernia repair under the RBP plan. The provider accepted the payment with no “balance billing.”

MedBen combines 80 years of benefits experience with forward-looking technology to keep your health care costs as low as possible. Learn more about our claims management advantage by contacting Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or bfargus@medben.com.

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