Adept Benefits | Innovative Healthcare Solutions

Case Study: Construction

Overview:

A high-end residential and commercial construction company's employees had not received advocacy from their previous broker relationship.

Background:

  • Privately held construction company

  • 100 covered lives

  • Provides a comprehensive, competitive benefit program at virtually no cost to the employees

  • Employees often had difficult times getting claims dispute assistance

The Challenge:

One employee had a large medical claim of $52,000 covered out-of-network and reimbursed at next to nothing. When Adept Benefits' employee benefit advocates began working, the employee had been fighting a 2-year battle with the insurance carrier, trying to get reimbursed.

The Solution:

After reviewing two years of documentation, Adept Benefits convinced the insurance carrier to reopen the claim, initiated a new appeal and collaborated with the member to create a compelling case for an external claim review team. In the end ADEPT BENEFITS was able to get all 3 claims covered for the member. Within 9 months, all money had been refunded. When there is a will, there is a way!

Savings:  $46,700

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