Claim Issues Assistance for Your Employees
Our ability to assist employees with claim issues has become a hallmark of our reputation. Our staff has been asked to intervene on behalf of employees for a variety of issues. In accordance with Privacy Regulations, all our staff members are trained in HIPAA compliance.
Our firm is very successful in assisting employees with claims adjudication issues through the insurance companies. In each case where a claim was incorrectly paid, we have facilitated the resolution. In addition to claim issues, our Service Team may be called upon to deal with administrative concerns such as incorrect billings and/or enrollment matters. Brown & Brown does not subcontract any aspect of claims handling for our clients.
Examples Of Claim Issues:
- Claim not paid in the same manner as previous carrier
- Claim denied due to “lack of” medical necessity
- Claim denied because of errors in provider coding
- Charge not fully covered by usual and customary allowance
- Rules of a plan not followed by employee
Our staff provides benefits education for employees ranging from new hire orientation meetings, new carrier implementation meetings, health fairs, or a more confidential benefits question and answer session.
In the event of a carrier change, our firm coordinates all aspects of the new carrier implementation including onsite employee education and enrollment meetings with the goal to experience a seamless transition.
When There’s A Carrier Change:
- Explain the benefits being offered and answer any questions about the benefits program
- Create a customized Open Enrollment brochure and distribute instructions on how to enroll with the new carrier, who to contact from our firm with any questions or problems, and how to have any deductibles or coinsurance amounts credited by a new health insurance carrier
- Review the benefits booklets to confirm the benefits are set up properly
- Review all contracts to confirm compliance with all federal and state regulations
Depending on the complexity of the issue, our goal is to resolve issues as quickly as possible. Our staff returns phone calls and/or emails within 24 hours, if not sooner. In recent years there tended to be delays at the carrier level, however, our staff follows up relentlessly to get answers for our clients. Our policy is to keep our clients in the loop during the process, so they are aware that we are working on their behalf to get the issue resolved on a timely basis.