CLAIMS

Frequent Issues:

• Assistance with referral forms for special care
• Emergency room copays
• Reasonable and customary reimbursement issues
• Resolution of medical expenses debts with collection agencies
• Verification of coverage for medical emergencies
• Resolution of provider billing as to contracted vs. market rate
• Assistance in pre-certification of hospital stays
• Coordination of medical, workers compensation and state DBL
• Out of area claims issues
• Assistance with completing claims forms
• Prior plan deductible credit
• coverage for non-routine services and equipment
• Preauthorization for new or experimental treatments
• Rx: Brand name vs. Generic drugs
• Assistance with mail order continuation drug program
• In-network vs. out-of-network Rx claims issues
• Calendar year vs. Plan year deductible issues
• Explaining medicare benefits to employees
• Coordinating insurance payments with medicare payments
• Assisting eligible employees in applying for medicare and supplemental coverage
• Expediting dental pretreatment authorizations