Introduction
In early 2025, a leading OB/GYN provider in Bozeman, MT encountered a major reimbursement setback. A $21,000 claim for a high-risk cesarean section was denied by a commercial payer due to “insufficient medical necessity documentation.”
Even though prenatal complications and emergency conditions were well-documented, fragmented records and a lack of an organized appeals strategy delayed resolution for months.
That changed when the provider partnered with Medical Billing Wholesalers. Using our proven OB/GYN billing and coding services, the claim was successfully appealed and reimbursed within 45 days—with long-term fixes introduced to their revenue cycle.
Client Overview
The client is a private women’s health clinic focused on high-risk pregnancies and complex obstetrics procedures.
Specialty: OB/GYN Billing & Coding Services
Location: Bozeman, MT
Average Case Value: $15,000–$25,000
Service Offered: Denial Management Services
Challenges Faced
Insufficient documentation: Risk factors and delivery notes weren’t clearly linked in claims.
Missed appeal deadlines: Lack of tracking systems caused critical filing windows to lapse.
No denial response workflow: Denials weren’t categorized, resulting in repeated errors.
Fragmented EMR systems: Patient data was spread across multiple platforms, making appeals inconsistent.
These issues are common in OB/GYN practices. If you’re experiencing similar delays, outsourcing your OB billing could help reduce denials and accelerate reimbursement.
Our Approach
Medical Billing Wholesalers conducted a comprehensive intervention to solve each denial barrier and recover the pending amount.
| Challenge | Corrective Action |
|---|---|
| Medical necessity unclear | Unified OB consults, prenatal notes, and maternal risks into one complete summary |
| Appeal deadlines missed | Set up calendar alerts and tracking tools within the EMR system |
| Unstructured denial response | Introduced a denial categorization matrix and pre-approved response templates |
| Disconnected clinical records | Integrated OB EMR with billing platform for faster, more consistent submissions |
Results
$21,000 recovered with a fully documented appeal
45% drop in OB claim denials within the first 90 days
62% improvement in appeal turnaround time
89% first-pass resolution rate for new OB/GYN claims
Conclusion
By partnering with Medical Billing Wholesalers, this OB/GYN provider not only overturned a major denial—but also strengthened their billing processes to reduce future revenue loss. The improvements in appeals, documentation, and system integration created a lasting impact on their financial stability.
Don’t Let OB Billing Denials Cost You Thousands
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