We have developed a Claim Counselors service that adds value to clients benefit programs by helping members navigate through the changing and complex healthcare systems. Claim Counselor representatives provide assistance to employees and human resource staff, allowing your employees to spend less time, including work-time, in finding the answers they need while having a higher level of satisfaction with their health plan. Our dedicated team of representatives will make the necessary calls to health insurance providers and carriers and obtain the necessary answers.
Kunkel & Associates Claim Counselors can provide peace of mind during a stressful time in relation to the following areas:
- Aid employees in understanding health-plan operations
- Out of pocket maximums
- Claims filing requirements
- Extension of benefits
- Flexible Spending
- Coordination of Benefits (COB)
- Requests for information
- Appeals process
- HRA/HSA concepts
- Investigate claims payment and/or eligibility accuracy when in question.
- Act as an intermediary between employee and insurance company or administrator as needed.
- Help employees become better healthcare consumers.
A member called one of our Claim Counselors regarding claims with dates of service that took place three months prior. They had not yet been paid and the member was receiving past due notices. The plan had moved from a fully insured to a self-insured arrangement earlier in the year. As a result of the change in plans, one provider had submitted claims to the prior carrier and another submitted a claim with an incorrect member ID number.
The Claim Counselor facilitated a call between the provider and claims administrator as it was not the standard process of the claims administrator to call providers to request claims submissions. The claims were resubmitted and paid appropriately. The results were communicated back to the participant throughout the process. The participant was thankful their credit history would not be adversely affected.
A self-funded plan was nearing renewal time and the Third Party Administrator (TPA) was trying unsuccessfully to obtain an outstanding inpatient hospital claim for a member who had exceeded the $25,000 specific deductible. The hospital would not release the claim for payment as the member had not signed the appropriate authorization form. The TPA called our office to relay the problem.
One of our Claim Counselors stepped in and obtained the appropriate form for completion. A phone call was made to the provider to confirm it was the correct form before sending to the member for completion. The executed authorization was sent to the provider and the claim was released for payment, resulting in an additional $20,000 specific reimbursement to the self-funded plan.
Contact a Kunkel & Associates Claim Counselor for additional questions.