HCC Short Term

[insuranceconceptscindy]

I have a client that purchased an HCC short term policy in September. She was super healthy, no issues, but felt like she needed something until her traditional policy kicked in 1/1/15.

So, she is travelling and winds up in the emergency room with a hemorrhage. They get her fixed up and send her on her way. Now she's getting bills from the hospital. The plan has only sent her a letter asking if the claim was due to a workplace injury and to explain what happened. She provided all of the details and they have not paid a dime.

I'm not her broker of record, I signed her up for her new plan. I know nothing about the company or how to get her claims paid. Does anyone have experience with these people?

 

[iHealthBrokers.com]

I have a client that purchased an HCC short term policy in September. She was super healthy, no issues, but felt like she needed something until her traditional policy kicked in 1/1/15.

So, she is travelling and winds up in the emergency room with a hemorrhage. They get her fixed up and send her on her way. Now she's getting bills from the hospital. The plan has only sent her a letter asking if the claim was due to a workplace injury and to explain what happened. She provided all of the details and they have not paid a dime.

I'm not her broker of record, I signed her up for her new plan. I know nothing about the company or how to get her claims paid. Does anyone have experience with these people?

We do a decent amount of business with HCC and have had good experience with them paying claims in the past.

 

[insuranceconceptscindy]

We do a decent amount of business with HCC and have had good experience with them paying claims in the past.

Have you had any issues? How do we get claims paid?

 

[somarco]

HCC could be looking to see if this is a WC claim or pre-ex situation.

 

[iHealthBrokers.com]

Have you had any issues? How do we get claims paid?

Somarco is spot on. As with many carriers, I'm fairly certain they may have had some inclination that it was either pre-x, or work-based, or whatever. We do see them doing pre-x investigations often, which can be a bit of a pain, but as long as your client was honest on the app and is quick to get them whatever info they need, they'll get the claim paid.

 

[kgmom219]

If she just got the policy in September and its now Dec 15, it hasn't been that long.

What was the date of service? Was the hospital in or out? (out will delay claims payment). Then they got it, sent it to subrogation, who now has to process it, then send it back to the insurance company for payment.

That's a lot of frigging steps. Call the company, have the received the subrogation information? If so, what are the next steps? Processing claims that were sent out to a subrogation company can be a lengthy process.

1. Call ICC see where they are and get an ETA of the next step.
2. Call the hospital (and other providers?) and let them know the claim went to subrogation and what the ETA is

Good luck!

 

[DS4]

So, she is travelling and winds up in the emergency room with a hemorrhage. They get her fixed up and send her on her way.

What was the DOS of the ER visit?

 

[AllenChicago]

If she just got the policy in September and its now Dec 15, it hasn't been that long.

What was the date of service? Was the hospital in or out? (out will delay claims payment). Then they got it, sent it to subrogation, who now has to process it, then send it back to the insurance company for payment.

That's a lot of frigging steps. Call the company, have the received the subrogation information? If so, what are the next steps? Processing claims that were sent out to a subrogation company can be a lengthy process.

1. Call ICC see where they are and get an ETA of the next step.
2. Call the hospital (and other providers?) and let them know the claim went to subrogation and what the ETA is

Good luck!

Perhaps it's best to let the agent who sold her this HCC STM plan earn his/her +20% commission by doing the legwork to assist his/her client?

 

[kgmom219]

Perhaps it's best to let the agent who sold her this HCC STM plan earn his/her +20% commission by doing the legwork to assist his/her client?

I'm assuming that the client bought it without an agent and is asking her current agent to help. Since she bought it in September and an ACA policy from Cindy in OEP

 

[somarco]

If Cindy isn't the AOR on the STM plan the carrier won't tell her squat without a HIPAA release. She can certainly advise her (new) client on what might be going on and tell her how to navigate the claim review but that's as far as it goes.