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Client/Member Aggravation
An employee called BenefitsVIP requesting assistance with a medical claim indicating he was responsible to pay a provider $11,489. He was extremely upset as he had received the approval for the procedure in advance.
BenefitsVIP Intervention
BenefitsVIP immediately called the carrier and reviewed the processing of the claim with the account manager. It was found that the claim was paid out of network because the employee had been activated under the incorrect group number. Further review showed that several others at the same company were in the wrong group. BenefitsVIP assisted with an eligibility and subsequent claims audit.
Resolution
All employees were put in the correct group number. All outstanding claims were reprocessed and paid correctly. The $11,000 claim was paid with no member liability.
Client Response
“You just made my weekend. I was trying to figure out a way to tell my wife we have a bill for $11,000. Thank you very much!”
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Foods that help your vision
Eat for Your Eyesight. Yes, eating salmon and other fatty fish can help with your vision. Researchers found that people who ate the most omega-3 fats (found mainly in fatty fish) had a 39 percent lower risk of advanced age-related macular degeneration than those who ate the least. If you're not a fan of salmon, more than two servings a week of any fish produced the same benefit.
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Diabetes tests are simple
If you are 45 or over have you checked to see if you are diabetic or no? It's a good idea to talk to your doctor about getting tested for diabetes, especially if you're over 45, overweight, or have a family history of diabetes. Early detection will minimize you and your fellow employees benefit costs. A diabetes test consists of a simple blood test done when the patient has not eaten for at least 10 hours. With diabetes, fasting blood sugar is at least 126 mg/dL. Fasting blood sugar is 100 to 125 in prediabetes. Normal fasting blood sugar is less than 100. Schedule your test today!
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What happens if I need care while I’m traveling?
If it's not an emergency and you need care while traveling, call your BenefitsVIP consultant and your they can help you arrange a referral. In a true emergency, get the care you need as quickly as you can. If you are able, contact your carrier, even in an emergency. However, even if you are unable to contact your carrier, get the care you need. Even if you need to seek care from a non-HMO provider, your plan will cover emergency care as long as you follow the plan rules. Check to see how your plan defines a true emergency.
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Beyond eating well and exercising, you need to check in with your doctor for exams and tests that can help catch serious problems at their earliest, most treatable stages. Early detection not only helps to minimize your out-of-pocket costs, it helps to minimize healthcare benefit costs for all your co-workers that are part of the plan. Since so much rides on these screens, it's important to get the most reliable versions. Here's how to make sure.
The only reliable colon cancer test. Of the several screening tools for colon cancer, only colonoscopy is accurate. Sigmoidoscopy, a popular alternative, misses 30 percent of advanced growths in men and 65 percent in women. For a colonoscopy, you are sedated, and a doctor can examine the entire length of the colon and to snip out any abnormalities encountered along the way. Pick a doctor with special training in colonoscopy, such as a gastroenterologist or a colorectal surgeon. How often? Once every 10 years, starting at age 50. Some doctors advise scheduling a colonoscopy every five years. Cost: About $1,000; not all health insurers cover.
A superior heart scan. Electron-beam computed tomography, a type of X ray, measures the amount of calcium in coronary arteries: the more calcium, the higher your heart attack risk. Studies have shown that EBCT is a far better predictor than either a stress test or a treadmill EKG. The test is advised for anyone at intermediate risk for heart disease (for example, those whose LDL cholesterol is between 100 and 160). How often? Varies according to test results, as well as your other risk factors. Cost: About $500; most health insurance companies do not cover EBCT.
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When Losing Actually Means Winning!
Achieving a healthy weight may reduce your health risks while lowering your out-of-pocket costs for healthcare benefits. What are the benefits of reaching proper weight? According to the National Institutes of Health, people who are obese (more than 20% above their ideal weight) are more likely to have hypertension, high blood cholesterol levels, and diabetes. It also makes you feel better — more energetic and more confident.
Ideally, both you and your physician should determine if you need to lose weight. If so, how far off are you from your "winning weight?" Is a complete change in eating habits necessary or do you just need to cut back a little? If you're close to your goal, you may not need to start a full-scale weight-reduction program. If you're more than 20% above your healthy weight, consult a health professional before starting any type of serious weight-loss program.
One of the first steps is to evaluate how you feel, both physically and emotionally, and establish realistic goals. If you want to lose weight, set several short-term goals, and reward yourself each time you make progress. Remember, even small weight losses have been shown to be beneficial.
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