ERISA Recovery Saves University Hospitals Millions

Dallas, Texas—August 24, 2023: The CEO of a Dallas healthcare fintech company today announced helping two medical systems affiliated with universities recover millions of dollars in unpaid health insurance claims.

Healthcare finance consulting firm ERISA Recovery collected $5.7 million for Chicago’s Northwestern Medicine and $3.1 million for the University of Miami Health System, or UHealth.  This revenue was from unpaid health insurance claims up to six years old.

“We’re proud to help these major medical systems and university hospitals recover almost $9 million,” said ERISA Recovery CEO Andre Kus. “Northwestern Medicine and the University of Miami Health System play important roles in providing critical care for adults, children, and cancer patients in the greater Chicago and Miami areas, and they train some of the best doctors and conduct important research. It’s satisfying to help them win for their patients, staff, and students.”

Northwestern Medicine

Northwestern Medicine is a nonprofit medical system affiliated with Northwestern University’s Feinberg School of Medicine. The ERISA Recovery team identified revenues for the Chicago hospital by successfully appealing rejected claims within the first month of onboarding Northwestern Healthcare’s records. Additionally, ERISA Recovery currently has $4.5 million of Northwestern’s previously written-off revenue still under appeal, with more than $10 million under evaluation.

“ERISA Recovery are experts in complex claim resolution,” said John A. Orsini, Senior Vice President and Chief Financial Officer of Northwestern Memorial Healthcare.  “They produced excellent results with rejected claims other consultants failed to recover.”

Northwestern Memorial Healthcare is the flagship hospital in a network formed in 2010 when it merged with Lake Forest Hospital.  Today the system has 10 medical centers.

ERISA Recovery uses proprietary artificial intelligence to analyze patterns in unpaid health insurance claims.  The company is also a leading national expert in the powerful but complex legislation known as the Employment Retirement Income Security Act, which regulates employees’ healthcare and pension benefits.

As a result of ERISA Recovery’s successful appeals for Northwestern Medicine, their insights into aged healthcare claims continue to produce more accurate revenue cycle reporting.  ERISA Recovery’s data mining system has also discovered potential revenue for other hospitals within the Northwestern network.  This ongoing process ensures that Northwestern continues to see revenue growth from claims insurance companies previously refused to pay.

University of Miami (UHealth)

ERISA Recovery also helped the University of Miami Health System recover denials exceeding $3.1 million in less than 18 months.   Another $3.7 million is currently under review. “UHealth presented us with a big challenge,” said Kus.  “Their denials involved intricate clinical details in cancer treatment.”

Kus said that The University of Miami Health System, or UHealth, was an ideal partner in the process.  “UHealth provided us with detailed records, and that made our job easier,” he said.  Despite Covid-19 fading as a force of social disruption, hospitals continue to suffer the aftershocks of the pandemic. Part of this is due to the huge increase in patient debt.

With each successful appeal, ERISA Recovery’s analytics improve, said Kus.  “The more we look at medical systems’ revenue cycle data, the more our system evolves and the better it is at customizing solutions to individual client needs—whether they’re in Chicago or Miami.”  Kus added that with life returning to a new normal after the pandemic, hospitals across the country are asking his company for help recovering unpaid health insurance claims.

Studies & Resources

An Urban Institute study found that 73 percent of adults in the United States have medical debt, and they reported owing most of that debt to hospitals.

Americans who have suffered the most during the COVID-19 pandemic are also the most likely to be saddled with medical bill problems and debt, according to results from a new Commonwealth Fund survey.

David M. Cutler, Harvard economist, estimates a $528 billion increase in medical spending to meet the demands of “long COVID.” Officially named postacute sequelae of SARS-CoV-2 infection, or long COVID, it affects nearly one in five people infected with COVID-19. Ultimately, long COVID will cost the United States $2.6 Trillion, Cutler estimates.  Full Article

Under our strained medical economics, insurance companies have become more aggressive and sophisticated in rejecting claims.  The value of rejected claims increased by 67 percent in 2022.  Insurance companies increasingly use artificial intelligence systems to deny claims and also weigh the risk of litigation with the likely profit of an unchallenged denial… often choosing the latter. However, revenue cycle directors must understand the rights of both hospitals and patients. For this reason, successful ERISA appeals are vital to hospitals’ revenue cycles and financial well-being.  That’s where ERISA Recovery can help.

The ERISA Effect

ERISA Recovery works with some of the largest university hospitals and medical systems to appeal commercial, Medicare and Medicaid Advantage Plan denials.  We do so without requiring an upfront payment or changing the normal procedures in medical systems’ central billing offices.  All we need to get started is access to a hospital’s revenue cycle data.  We can often file the first appeals within three days. Within three weeks, ERISA Recovery begins winning appeals for hospitals.  We typically recover an average of $1 million or more within the first three months.

Contact us today for a free consultation.