~$1.13M in recovered and identified value.
Sarah Bush Lincoln Health Center partnered with gabeo.ai on a 90-day pilot of ZOE beginning September 2025. A forensic re-audit of zero-balance, payer-denied accounts produced a $6.89M write-off dataset and two action areas: claim-level appeal workflows, and potential contract breach denials flagged for payer escalation.
A $6.89M write-off dataset. Two paths to recovery.
ZOE re-audited SBLHC's zero-balance, payer-denied accounts against contract terms, payer reimbursement policies, and historical adjudication behavior, isolating a write-off dataset of 7,479 claims totaling $6.89M in billed charges. Triage routed the dataset three ways: 3,066 claims ($4.13M) to claim-level appeals, 2,016 claims ($1.2M) flagged as potential contract breach denials for payer escalation, and 2,397 claims ($1.56M) deprioritized where balances fell below the cost to appeal or appeal rights were exhausted.
From $0 to $377K in cash. 58% overturn rate on decided appeals.
All 3,066 appeal packets ($4.13M in billed charges) were filed within the 90-day pilot; payer decisions and cash posting continued through April 2026. To date, 1,414 claims have paid: a 58% overturn rate on the 2,450 decided (46% of all filed), with 616 still pending payer determination. Gabeo handled the full workflow, from root-cause audit to appeal drafting with contract and policy citations, submission, and follow-up; SBLHC's role was limited to authorizing recommended actions.
View payer and denial-category detail Hide detail
| Payer | Charges Billed | Cash Posted |
|---|---|---|
| Aetna · appeals | $1,976,907 | $168,542 |
| Aetna · reprocessing | Included above | $133,300 |
| UHC Insurance Co. | $521,889 | $32,656 |
| UHC Medicare Advantage | $742,119 | $16,322 |
| Meridian Complete | $90,454 | $9,218 |
| UHC Complete Care | $518,713 | $8,098 |
| Meridian Health Plan | $141,979 | $7,230 |
| BCBS of Illinois | $107,126 | $0* |
| Other | $26,556 | $1,234 |
| Total | $4,125,743 | $376,600 |
| Denial Category | Claims | Paid | Cash Posted | Paid ÷ Filed |
|---|---|---|---|---|
| Timely Filing (incl. TFL) | 2,454 | 1,287 | $195,402 | 52.4% |
| Authorization | 61 | 25 | $34,228 | 41.0% |
| Coding Error | 524 | 102 | $13,651 | 19.5% |
| Other | 27 | 0 | $19 | 0.0% |
| Total | 3,066 | 1,414 | $243,300 | 46.1% |
A second engine of value: $750K from potential contract breach denials.
ZOE's audit flagged 2,016 Aetna commercial claims, implicating $1.2M in billed charges, where timely-filing denials conflicted with the filing-limit terms of SBLHC's provider agreement. Gabeo pre-matched every claim to the contract provision at issue and packaged the set for payer escalation, so SBLHC acted with claim-level evidence in hand instead of researching account by account. The resolution had two parts: Aetna reprocessed the historical claims ($133.3K posted to date) and corrected its timely-filing adjudication prospectively, a client-validated ~$750K per year in avoided write-offs.
How escalation differs from appeals Hide explanation
>16X ROI on a fixed $22,500 fee.
Flat fee, no contingency, no percentage of recovery, no clawback risk. Every dollar recovered was already booked as a loss; it is pure incremental revenue.
| Metric | Actual (cash) |
|---|---|
| Gross appeals recovery | $376,600 |
| Engagement fee | ($22,500) |
| Net to hospital | $354,100 |
| Gross ROI (cash ÷ fee) | 16.7X |
| Net ROI (net ÷ fee) | 15.7X |
SBLHC is moving forward: a 3-year MSA and full integration.
The pilot results were presented to SBLHC leadership. On the strength of both workstreams, SBLHC is now moving forward with a 3-year master services agreement and direct integration, which will yield even better results: faster turnaround, higher win rates, and recovery running continuously instead of in batches.
"ZOE went after claims we had already written off and turned them into posted cash, without adding a single FTE to my team. The contract findings on Aetna alone changed how we think about our write-offs."
What's hiding in your write-offs?
Most health systems are sitting on millions in claims they've already accepted as lost. We'll show you what's recoverable in a 90-day pilot: no integration, no additional headcount.
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