Handling Claims for clients

[Executive Benefits]

I just went independent within the past month, the company where I had my book prior handled claims, which I am not comfortable with. ( dealing with problem cliams, and basically being the middle man for the insured) any suggestions? It screams liability to me. lol Not sure how you guys handle problem claims.

 

[The Rabbi]

I am an insurance agent who markets and enrolls. The insurance companies have claims departments. I wouldn't know what I could do getting involved. It's between the providers and the carrier.

 

[somarco]

I will get involved, but only because I have handled & negotiated claims for a long time. If you don't understand insurance, and how to read EOB's, you need to leave that area alone.

 

[LGilmore]

It's far more difficult with Hippa to help a client's claim problem. Things I could solve in 5 minutes or less now take a while as I have to get the client to walk through the paces to fix a problem. In the old days I could call claims walk through the eob find the problem and fix it quickly. Now days because of the unintended ripple from hippa... days to weeks.

 

[ABC]

I handle claims all the time for my clients. The hippa laws at first were a pain but now have calm down a bit.

The key to handling problem claims is understanding the claims process. Then understanding benefit design and how it applys. Understanding the EOB and how the claim was processed. Then understanding the coding of the cliam by the provider.

The key to making the claims process go faster is having relationship all ready built with the claims processors.
I will call them everyday until the claim is fixed and processed correctly.