Valerie thought she had received a prior approval of coverage for a medical procedure but after receiving a bill for $152,000, this was not the case.

In June of 2019, Valerie underwent a medical procedure which included a high cost medical device.  Prior to the procedure, she thought her doctor’s office had received a pre-approval of coverage from her insurance provider.  Months after undergoing the procedure she received a surprise in the mail.  Valerie got a bill with a patient responsibility of $152,000 and a letter from insurance stating that the procedure was not covered due to lack of medical necessity.

This catastrophic bill was overwhelming and upsetting for Valerie as it came as a massive surprise.

“If I would have known that the procedure wasn’t going to be covered, I would have looked for alternatives, but when the doctor’s office had confirmed coverage I decided to proceed.” After numerous attempts to receive adequate information from the provider and insurance had failed, Valerie looked for other options.

Valerie was connected to an Athos advocate through her employer’s healthcare assistance program, who was able to help resolve her case through constant communication with the member, insurance, and the provider.

The Athos advocate “was an enormous help and did a spectacular job in contacting both my doctor’s office and insurance company to gain more information on my case.  He provided me regular updates and the steps that were taken.  He worked tirelessly to ensure that I was not responsible for the billed insurance amount since I paid my co-pay.  In addition, he contacted my doctor’s office multiple times to obtain the information needed to submit to the insurance company so that the doctor’s office could receive compensation.”

“The help I received from Athos was above and beyond what needed to be done.”

The level of service received from Athos was “exceptional” according to the Valerie. “My advocate worked timelessly on my behalf and was a genuinely thoughtful person. He truly was a pleasure to work with.”

Knowing that she was facing a catastrophic medical bill was extremely stressful but once connected with an advocate she was able to focus on work, family, and everyday life without the burden of a surprise medical bill.

“Once I knew that Athos was working on my case and I was informed that there were multiple avenues to resolve my situation, it took a huge weight off of my shoulders where I was able to focus on my job and reduced stress in my life overall. Having the benefit of a healthcare advocate is unparalleled and I am extremely grateful to have access to this service through my employer.”

Athos will apply the same practices and concepts to help you and your employees save money while saving time and stress to your benefits coordinators and HR teams.‍

Contact us at contact@athoshealth.com to learn how we can help your organization and click the link to explore our website. Remember, choosing the right plan and offering healthcare advocacy programs will save your organization and its employees money. Athos is here to help navigate through the financial complexities of the healthcare system.