Claim Assistance

The rise of managed care has led to more and more complex health plans. Your employees have experienced this complexity, as more authorizations are needed to visit approved providers and thus have increased the number of “hoops” one must jump through. The result: more claim issues for you, the employer, to resolve.

Why not have an independent, trained team of professionals assist in resolving your employees’ claim problems?

Our call center ensures the “human factor” is always a part of the claim resolution equation. We are all tired of the endless telephone trees and voice response networks whose only purpose seems to be to reduce us to numbers. Your employees are never a number to us. A real person answers every call. A person trained to solve problems, find solutions and get to the correct answer.

Resolving claim issues begins with a call to our 800 number Hotline.
(See BeneSource® Hotline)

Many calls can be simply answered on the spot. Questions often involve simple misunderstandings on how your plan works. However, for more difficult claim issues, our benefit specialists follow the following protocol:

• Once it is determined that our specialists must contact a provider or insurance carrier, we mail an authorization form to your employee to complete. This form allows our benefit specialist access to your employee’s Personal Health Information (PHI) relative to the claim issue.
  
  
• Once we receive the completed PHI authorization form, the relevant information is entered to our Claims Assistance Database.
  
  
• The benefit specialist then begins investigating the unresolved issue, contacting the various parties involved.
  
  
• The benefit specialist stays in continual contact with your employee so they understand what actions are being taken on their behalf.
  
  
• The benefit specialist advises the employee of the resolution that has been achieved. Should a formal appeal by the employee be needed, our benefit specialist will assist in its preparation.