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“The Case of the Painful Pinkie”

04/20/18

  10:59:00 pm, by MedBen5   , 231 words,  
Categories: Cost savings, MedBen University, Claims management

“The Case of the Painful Pinkie”

Kurt Harden

Clinical reviews are an essential component of MedBen claim management, as our team of medical specialists ensures that your plan’s claims are paid accurately and in line with prevailing regional costs. At our recent MedBen University roundtables, MedBen President and COO Kurt Harden has highlighted several examples of actual clinical reviews … including an incident involving, of all things, an unfortunate pinkie finger.

As Harden tells the story, a police officer smashed his pinkie, causing its fingernail to grow in improperly. “The deformed pinkie nail interfered with the officer’s job performance, as he was unable to grip his service revolver properly,” Harden noted. The decision was made to have the nail removed via a laser procedure at an outpatient surgery center.

In its claim to MedBen, the surgery center charged $35,500, its standard rate for a nail removal. Our contracted discount brought the claim charge down to a more reasonable $28,000… but before the claim was paid, our claims surveillance system flagged it for clinical review.

After studying the claim, a medical specialist noted that Medicare pays no more than $500 for nail removal, and recommended that $2,000 was a fair cost for the procedure. So MedBen worked with the surgery center until they agreed to the lower cost.

For more examples of how MedBen’s cost containment solutions help employers reduce their health care spending, contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

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