SCOTTSDALE, Ariz., Oct. 23, 2020 /PRNewswire/ -- Advanced Reimbursement Solutions LLC (ARS), a Scottsdale-based medical billing and revenue cycle management enterprise, challenged Blue Cross Blue Shield of Arizona (BCBS of AZ) for its approval and subsequent denial of a double-mastectomy patient. The patient, Colleen L., was told by BCBS of AZ her mastectomy would be covered by her health insurance but later received a $25,000.00 bill for the procedure. ARS took the case to the Arizona Department of Insurance, seeking an external medical review to overturn BCBS of AZ's denial. Due to ARS's efforts the external review reversed the denial, and BCBS of AZ paid Colleen in full.
Colleen had a family history of breast cancer and was found to carry the BRCA1 gene-marker associated with heightened risk for breast cancer later in life. After consulting with numerous specialists who unanimously advised in favor of the prophylactic surgery, Colleen underwent a radical double-mastectomy. Prior to the procedure, Colleen was assured her procedure would be covered by BCBS of AZ for medical necessity. However, after the procedure took place, BCBS of AZ reversed itself, failed to notify Colleen, and left her and her family with a $25,000.00 bill. With its extensive expertise in overturning denied claims, ARS countered with the assertion that breast cancer would have likely skipped over her father, given the significantly lower risk of breast cancer in men.
ARS appealed the case to the Arizona Department of Insurance, as Colleen was receiving threats of being sent to collections for the outstanding bill.
As chance would have it, on Colleen's birthday, ARS informed her their efforts had prevailed, the denial had been overturned, and her money would be returned to her. "It was a lost cause. We were exhausted and felt victimized. ARS just kept fighting for me and it felt like a miracle when I heard we'd won. It was the best birthday present of my life," says Colleen. She credits the experience, determination, and tenacity of the ARS team who fought tirelessly on her behalf.
"Far too many patients fall victim to the nefarious tactics of insurance companies, but they have recourse, and that's where we step in to take up the battle as their advocate," says Gregory Maldonado, President of ARS.
Advanced Reimbursement Solutions, a subsidiary of Pantheon Global Holdings, LLC., is a family-owned company specializing in out-of-network medical billing, medical practice management and marketing, leading-edge technology solutions and full revenue-cycle management.