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• Billed Charges: $93,500

• WellRithms Reductions: $79,365

• Final Payment: $14,135 (15% of billed charges)

Significant Findings

An injured worker in Nebraska required air ambulance transport for 125 miles. WellRithms found inflated charges exceeding $79,000 in the bill for $93,500. The final payment of $14,135 (15% of billed charges) was disputed by the provider but upheld in arbitration.

Background

An injured worker in critical condition required a 125mile, one-way air ambulance transport in Nebraska. The base price charged for the service was $93,500. Air ambulance services are known to be costly and are a major concern for payors across the board to contain costs and ensure necessary medical care for their members. The bill required thorough review to ensure only reasonable and necessary charges were paid.

Results

To correct for excessive or inappropriate charges, WellRithms reviewed the bill to determine the actual cost of the airlift and the services performed during transit. The cost data was compared with actual accepted payment data from commercial insurers, private payers, and CMS. This was combined with geographical and state-specific financial considerations and inflationary adjustments to recommend a price in line with industry standards.

A WellRithms’ physician review complemented the company’s cost-based repricing to ensure that the insurer was not charged for any unnecessary services or equipment. Using validated cost data ensures that the adjusted charges are not only equitable but also legally defensible.

As is commonly the case with excessively priced air transport services that payors question, this WellRithms recommended amount was challenged by the provider and went to arbitration. WellRithms provided substantial data to support its payment rationale based on its cost analysis, reported and accepted payments for like services, and its physician review of the services performed during transit.

WellRithms’ recommended payment was upheld, resulting in an 85% reduction in the air ambulance cost for the insurer. The injured worker received the necessary medical attention, and the insurer paid a fair and reasonable amount for the transport service.