Case studies
Each example is a representative bill — the kind of pattern the rule engine flags. We will replace these with real anonymized customer wins as they accumulate.
Hospital billed a top-tier emergency code (99285) for a routine ankle sprain. Estimated overcharge: $1,000+.
A patient walks into the ER with a sprained ankle. They get an X-ray, an ankle wrap, and a prescription for ibuprofen. The hospital bills CPT 99285 — reserved for life-threatening or critical presentations — instead of the level appropriate to the documented care.
Routine knee surgery at an in-network hospital — but the anesthesiologist was out-of-network and tried to bill $3,200 above the insurer-allowed amount.
The patient verified the surgeon and the hospital were in-network. After the surgery, a separate bill arrived from the anesthesia group — out-of-network. The No Surprises Act caps patient responsibility at in-network cost-sharing for this exact scenario.
Same IV insertion charged three times for a single visit.
During a single ER visit a patient had one IV placed. The bill includes three identical "IV start" charges at the same price.
A comprehensive metabolic panel was billed as one combined code AND the individual components.
The lab ran a CMP (CPT 80053), then itemized each individual chemistry (glucose, sodium, potassium, etc.). CMS NCCI edits prohibit this — the individual codes are bundled into the panel code.
Facility fee was 70% of an outpatient bill — far higher than CMS expects.
Patient had a brief outpatient consultation and a single injection. The facility-fee line was several times the actual treatment charge and was duplicated across two line items.
$8,400 bill sent to an uninsured patient who was eligible for the hospital's 501(r) financial-assistance policy.
Uninsured patient with a $8,400 emergency-room bill. The hospital is a nonprofit but never provided a financial-assistance application. Federal law requires 501(c)(3) hospitals to widely publicise and apply the policy before collection.