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October 28, 2020

Member Profile: Daksha Gupta

Athos Health Team
|
5 Min

We’ve said it before, and we will say it again...

Dealing with healthcare can be complicated and extremely frustrating. It sometimes feels impossible to get a straight answer from anyone about what services will be covered by your insurance. Daksha Gupta can certainly attest to this experience.

Late last year when Daksha was pregnant with her first child, she received conflicting information from her insurance representatives about which necessary and optional tests/screens would be covered in full by her plan. Under the assumption that the testing she chose to move forward with was covered, Daksha was surprised and confused by the bill she received in the mail. In full, Daksha was being billed more than $1,500 for services she planned on costing her zero.

Daksha knew that there must be some mistake

After multiple calls and chats to her insurance customer service center, she was getting nowhere.

“Being a first-time mother, it was so important to me during my pregnancy that I understood and took all the necessary steps to make sure that my baby would be healthy and happy. I felt mislead when the information I had received contradicted the bill I was holding, and this feeling only grew as I tried unsuccessfully to sort it out with the insurance carrier over the course of many months.”

In need of some help, Daksha reached out to her HR department and was immediately connected with an Athos Health Advocate who got to work on her case.

“Having someone in my corner who was listening to me and promising to do everything possible to solve the issue in my favor provided me a great amount of initial relief, even before a resolution was reached.”

After reviewing all the documentation that Daksha provided, her advocate was able to determine that five of the tests she received had been billed to her by mistake due to an error by her insurance company. Many of the lab tests ordered by her doctor should have been considered“preventative care” and Daksha should have had no financial responsibility.

Athos saved Daksha over $500

Ultimately, Daksha’s tenacity in getting this resolved paired with the knowledge and hard work of her advocate led not only to a drop in her bill of over $500, but it also uncovered a systematic error that insurance company had been making for 8 years on these same tests during all prenatal visits. The enormity of this discovery goes to show how often members are unaware of what they are paying for and why, and how the sheer complexity of our less than perfect healthcare system can and will take advantage of unsuspecting consumers who assume they are being cared for.

Our advocates takes the burden off HR

Now all of that said, it is not our intention to call out any person, provider, or even insurance agency for being malicious, but at Athos Health we believe that the number of rules, regulations and policies changing at a rapid pace make it near impossible for the average person to keep up. This includes HR teams who are often tasked with answering tons of healthcare questions for their employees. With our advocacy programs we aim to take the burden of being the expert off HR departments and members. It’s our mission to ensure that members are protected from paying more than they should for services and allow them to focus on the life in front of them.

“Working with my Athos Advocate allowed me to focus on what was most important—my health and the health of first child. I was so happy when the insurance company agreed to pay for those tests and thank my advocate for all the care and time they put into my case.”

Contact us at contact@athoshealth.com to learn how Athos will apply the same practices and concepts to help your employees with surprise medical bills, so you can all get back to business as usual. The healthcare system is complex, but we are here to help.

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