Background

In 2020, during the height of the COVID-19 pandemic, a U.S. patient was admitted to a foreign hospital with severe symptoms and ultimately expired. The patient’s U.S.-based insurer issued a Guarantee of Payment (GOP) for the care, which ultimately exceeded $260,000 USD.

Unfortunately, the patient passed away during the hospitalization. The payer ceased communication with the hospital. Despite repeated outreach attempts over the course of four years, the hospital received no response or payment.

Challenges

• Confirmed GOP, but no follow-through: Despite the written authorization, the claim was not processed or paid.
• Four years of payer silence: The hospital received no communication despite repeated inquiries.
• Deceased patient: Standard patient-side escalation was no longer possible.
• No established escalation path: No contacts / departments within the payer organization were responsive to the case.

Solutions by Riviera RCM

The hospital assigned the case to Riviera RCM in 2025 to pursue resolution. Riviera immediately initiated a strategic, multi-channel recovery process:

• Claim Reinitiation: Reopened the claim file with the insurance payer, referencing the original GOP and documentation of non-payment.
• Multi-Department Escalation: Engaged several departments within the insurance organization — including claims, legal, provider services, and executive support — through coordinated outreach.
• High-Frequency Communication: Leveraged persistent phone and email communication, logging over a dozen touchpoints with specific demands and deadlines.
• Documentation Reinforcement: Supplied complete medical and billing records, death certificate, GOP confirmation, and correspondence history to eliminate delay excuses.