Your Employees Flag It. We Fight It.
Medical Bill Shield runs the Independent Medical Bill Audit, an employee-triggered system. We don't audit every claim. We investigate the ones that feel wrong, and we document every action for your fiduciary records.
The Canary in the Mine
Your employees feel billing problems first.
They know when something doesn't add up.
Step 1: Employee Uploads Bill
An employee receives a bill that feels wrong. Maybe it's too high, maybe there's a denial that doesn't make sense, maybe they were told one thing and billed another. They upload the bill, the EOB, and any denial letter through our secure portal.
Secure, HIPAA-compliant upload
No technical knowledge required
Step 2: Routed to a Physician-Trained Advocate
Our intake system identifies red flags and routes each case to a physician-trained Certified Medical Bill Advocate (CMBA). The advocate compares the employee's own account of what happened against the billed CPT codes. The patient is the source of truth.
What the review looks for:
- Upcoding (billing for a more expensive service than provided)
- Unbundling (separating charges that should be billed together)
- Duplicate charges
- Balance billing and in-network overbilling (providers charging beyond what the plan allows or the contract permits)
- Charges that don't match the diagnosis
Step 3: Verify, Correct, Resolve
Our CMBAs verify the bill first: did the billed codes match the care the employee describes? Wrong bills get corrected or eliminated, and inappropriate denials get appealed. When a charge is legitimate but inflated, they contact the provider directly and negotiate it to a fair 2x Medicare benchmark.
Why 2x Medicare rate?
For charges that are legitimate but overpriced, we need a fairness benchmark. Providers are allowed to bill above Medicare rates. It's just a question of how much more is reasonable. Studies show that 2x Medicare covers provider costs while remaining fair to patients. That's our target.
Step 4: Document Everything
Every action is documented in your fiduciary compliance record. The initial flag, the investigation, the negotiation, the outcome. When DOL asks what you did to protect your employees under CAA 2021, you have the receipts.
Your compliance record includes:
- • Date and time of employee flag
- • Intake analysis findings
- • CMBA investigation notes
- • Provider communication logs
- • Final resolution documentation
Why This Gap Exists
Your TPA and broker aren't protecting your employees from billing errors.
It's not their job.
| Capability | TPA / Broker | Medical Bill Shield |
|---|---|---|
| Audits individual employee bills | ||
| Negotiates with providers on employee's behalf | ||
| Catches coding errors and upcoding | ||
| Appeals unfair insurance denials | ||
| Documents fiduciary compliance |