Case Studies

Advocacy that Makes a Difference

Client: 125 Employees, Healthcare Industry

Situation: The child of a client’s employee suffered a fall and broke five teeth while away at college. Over the course of a couple of months, the student needed two root canals, an ambulance ride to the hospital, an emergency room visit, a CT scan and restorative work on her teeth.  After multiple bills from different medical and dental providers began to accumulate, the employee contacted the insurance companies to find out which services were covered but got inaccurate  information.

Solution: The Paradigm Group claims advocacy team worked directly with the employee to explain the various bills and ensure that claim were filed correctly. In addition, the team convinced the student’s out-of-network dentist to accept the insurance company’s in-network fees as payment in full and to file claims with the medical plan rather than with the dental plan.

Outcome: The employee’s expected out-of-pocket expense was $15,000 – $20,000 if claims were filed and paid by the dental plan instead of the medical plan.  With Paradigm Group’s intervention, the employee paid less than $4,000.

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