​Case Study: Recovering Insurance Underpayments for a Private EMS Agency
Overview
A private 911 ground ambulance provider in upstate New York was experiencing consistent insurance underpayments on non-contracted commercial claims. Despite standard billing and appeals, these balances were routinely written off as unrecoverable.RVNU EMS was engaged to determine whether meaningful recovery was possible beyond existing billing workflows.
Agency Profile
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Private, non-profit EMS provider
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Approximately 2,500 calls and 1,600 transports annually
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Mixed commercial and government payer mix
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Non-participating with several major commercial insurers
The Problem
The agency identified a recurring issue:
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Commercial claims were being paid at amounts labeled “usual and customary,” well below billed charges
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Standard billing and appeals processes failed to move these claims
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Balance billing was not a viable or desirable option
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Underpayments were accepted as final, contributing to ongoing revenue leakage
Leadership suspected the issue was systemic — not isolated — but lacked a practical path forward.
What RVNU EMS Did
RVNU EMS conducted a focused review of historical claims data and identified a pattern of underpayments concentrated among specific payers and claim types.
Rather than replacing billing operations, RVNU EMS:
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Analyzed paid claims to identify underpayment patterns
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Reviewed historical data going back multiple years
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Pursued recovery using payer-specific, pre-legal and legal escalation strategies
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Engaged directly at the payer level to challenge improper reimbursement practices
All work occurred outside the agency’s existing billing workflows.
The Results
Within the first 60 days:
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Over $200,000 in historical underpayments were identified
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More than $80,000 in previously written-off payments were recovered
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The agency’s most problematic commercial payer began paying new claims at appropriate rates
As a result, the agency realized:
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Immediate recovery of past revenue
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An estimated $25,000–$30,000 in recurring annual revenue going forward
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Reduced reliance on write-offs as a default outcome
Why This Mattered
The engagement demonstrated that the agency’s underpayments were not unavoidable — they were the result of workflow limitations, not coverage limitations.
By addressing these gaps outside standard billing, RVNU EMS helped correct payer behavior and recover revenue that would otherwise have remained lost.
How RVNU EMS Engages
RVNU EMS operates on a contingent basis and works alongside existing billing teams. We focus exclusively on underpayments and recovery opportunities that fall outside the scope of standard billing operations.
If recovery is not viable, we say so.