3 weeks ago the facility quoted us billed charges of over $13,000 per dose for the patient’s chemotherapy drugs. We know the Wholesale Aquisition Cost of those drugs is under $700 per dose. (Thank you micromedex!) .

SOURCE: Deb Ault Nurse Deb – President at AIMM, Ault International Medical Management5d

More than TEN phone calls to the facility attempting to negotiate a more fair and reasonable pricing were unsuccessful, so the Care Manager asked me to get involved.

I called the facility’s CFO. Ended up leaving some detailed voicemails. Today we get a call from the facility’s contracting person telling us that “we corrected our billing mistake” and that the billed charges for the drugs was corrected to less than $2000 per dose – and that’s before the PPO discount.

Would the plan have overpaid by more than $11,000 a dose had we not been involved? I’m pretty sure they would.

This is PROACTIVE Care Management


Editor’s Note: Claim audits – what a novel idea!  Most plan sponsors don’t audit their claims using independent outside audit companies. That’s because they believe in magic – Do You Believe In Magic? 

AMPS is an independent audit firm recommends to clients who don’t believe in magic………..

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