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In-Depth Health Claim Review Saves Client Up to $15,000 on Surgery that Fails to Meet Standards for Medical Necessity
Date:9/30/2013

w experience, many past cases have shown that clients are commonly misdiagnosed with CTS instead of thoracic outlet syndrome or other conditions that often include similar symptoms.

The first expert, a board-certified neurologist, found that the EDX testing was not medically necessary as there was little description of history and response to more conservative measures like wrist splints or physical therapy.

The second review was done by a physician in orthopedic medicine who determined that the exam and EDX testing showed no definitive signs that the client had CTS.

Doney explained that employers who self-fund their employee benefits need to be extremely vigilant. “If it weren’t for this claim review, our employer-client would have had a surgery that cost thousands of dollars to fix a condition that wasn’t even present,” he said. “The effects go well beyond the price tag – a painful recovery, limited function and lost work time are just a few.” He added, “As a patient navigating today’s ever-changing health care system, being proactive is essential. Ask questions and make sure the tests and procedures your providers are ordering are medically necessary.”

Since starting business in 2000, Cypress Benefit Administrators, a privately held company headquartered in Appleton, Wis., has evolved into more than a third party administrator (TPA) by pioneering the way toward cost containment in health benefits. Cypress is the country’s first TPA to bring claims administration, consumer driven health plans and proven cost control measures together into one package. Its customized employee benefit packages combine an appropriate mix of health insurance options that allow for adaptability to the ever-changing healthcare environment and that make sense for employers of 50 to 18,000+ throughout the United States. For more information on Cypress Benefit Administrators with offices in Portland and Salem, Ore., Omaha, Neb. and Colorado Springs, Col.,
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