When a $316,383 workers’ compensation bill arrived for examination by the WellRithms’ physician and surgeon bill reviewers, they agreed that the egregious spinal cord surgery charges were reminiscent of the Mother Goose rhyme, “There was a crooked man….”
Surgicore of Jersey City, an ambulatory surgical center in New Jersey, performed surgery on a single vertebra in a man’s lower back – just one of the 24 vertebrae that surround and protect the spinal cord and nerves.
For that single service they charged $120,338, and then they billed for five other service lines that were not payable. This included two unlisted procedures for $30,000 combined and two decompressions to relieve back pain that were billed at $162,929 combined. Payors don’t pay for spinal decompression treatment for back pain alone because there isn’t enough scientific data to support the benefits of the technique.
WellRithms repriced the allowable service line to $8,133 and denied the rest, which reduced the overall charges to 2.6% of the original bill – and a happy ending to a wildly inflated surgical bill.
For more information on how WellRithms can get you results, contact info@wellrithms.com.
