Case Study: a large third-party administrator’s health plan saves a member $51K with Zelis Health Bill Assist

a large third-party administrator’s health plan saves $51K on an out-of-network bill with Zelis

A member of a large third-party administrator's health plan was unexpectedly billed $51,000 for a routine surgery, a significant discrepancy from the initial estimate of $2,800. The challenge involved resolving this out-of-network billing error and alleviating the member's financial stress. Zelis, through its Health Bill Assist service, was engaged to help navigate and negotiate the confusing bill.

Zelis assigned a bill navigator to the case who investigated the bill and discovered a hospital miscalculation. The solution involved guiding the member through the hospital's financial aid application and persistently negotiating on their behalf. As a result of Zelis's expert advocacy, the hospital recognized its error and significantly reduced the bill, saving the member $51,000 out-of-pocket.