How it works
From first case file to settlement.
Every engagement follows the same pathway. It begins with a sample of settled claims and ends with recovered value or a clear account of why a claim did not hold. Nothing rests on assertion. Everything rests on the file.
The engagement pathway
Six stages. Each one documented.
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Initial review
You provide a sample of settled international claims. We compare each settlement against the clinical record and the billed amount, and report where value was left behind. This stage costs nothing and commits you to nothing.
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Terms and data agreements
If the findings justify going further, we agree a contingency fee as a fixed percentage of recovered value, and we sign a data processing agreement before any patient record moves. The paperwork is short and written to be read.
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Case preparation
Each claim is rebuilt from its source documents: the clinical record, the coding, the invoice, and the insurer's settlement statement. Working papers use patient initials only. The result is a file that states exactly what was billed, what was paid, and what remains owed.
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Clinical validation
Clinicians assess whether the care given was justified and whether it was coded correctly. Every opinion is standard-driven, documented, and referenced to the clinical record. Where the original billing overstated the position, we say so, because a file that concedes weak points carries the strong ones further.
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Negotiation
The validated file goes to the insurer with a stated figure and the evidence behind it. Discussions stay professional and specific. Most disputes narrow quickly once both sides are looking at the same documented record.
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Recovery and settlement
Where negotiation does not resolve a claim, it can pass to a solicitor through a separate legal entity, with the file already prepared to legal standard. The decision to proceed rests with the hospital at every point. On settlement, you receive the recovered value less the agreed percentage, with a full account of how the figure was reached.
The methodology
Written to withstand scrutiny.
A clinical opinion is only worth what it can survive. Ours are built to be examined by the insurer's own advisers, by an auditor, or by a court, and to read the same way to each of them.
Standard-driven
Every opinion is anchored to published clinical standards and coding guidance. The reasoning starts from the standard, and the standard is cited in the working papers.
Documented
Each finding is written down with its basis, its author, and its date. There are no verbal positions. If a view changes as evidence emerges, the record shows why.
Auditable
Every figure traces back to the clinical record and the billing data. A third party can follow the file from conclusion to source without needing anything explained.
Data handling
Patient data, handled with the care it requires.
Clinical records sit in the most protected category of personal data, and we hold ourselves to that standard wherever we operate. UK engagements are governed by UK GDPR; engagements elsewhere are governed by the data protection law of the jurisdiction concerned. In every case the obligations are agreed in writing before any record reaches us.
A data processing agreement with every hospital
Before an engagement begins, we sign a data processing agreement that sets out what data we receive, what we do with it, how long we hold it, and how it is returned or destroyed. The hospital remains the data controller throughout.
Initials only in working papers
Working papers, correspondence, and negotiation files identify patients by initials and claim reference. Full identifiers stay within the source records, and access to those records is limited to the clinicians reviewing the claim.
Only the data the claim requires
We take the records needed to assess the disputed claims and nothing beyond them. When a matter closes, data is returned or destroyed on the schedule the agreement sets out, and we confirm that in writing.
Next step
Begin with the sample review.
Send us a sample of settled international claims and we will tell you what they were worth. The review is without cost, and the findings are yours either way.
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