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Client/Member Aggravation
Ming received a medical bill stating that her son had no medical coverage at the time of service. The emergency room bill was for $1,365.87. Ming called her BenefitsVIP team and explained the issues and all the details from the denied bill. BenefitsVIP Intervention
The BenefitsVIP representative called the carrier to investigate and was told that Ming’s son’s full time student status was never updated so the representative completed the required forms and the dependent was reinstated with no lapse in coverage.
Resolution
Ming only had to pay the copay of $50.00 for the emergency room visit. The resolution saved Ming $1,315.87 and peace of mind.
Client Response
“Thanks for helping my son.” |
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| Denise went to her usual in-network dermatologist and in the explanation of benefits the charges were going towards her out-of-network deductible. She called BenefitsVIP to obtain clarity on the issue. BenefitsVIP contacted the carrier and confirmed that her dermatologist became a non-participating provider after January 1st. Since the provider never advised that he was no longer participating with her plan BenefitsVIP was able to have all related claims processed in-network, saving Denise thousands of dollars. |
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| Phillip received a medical bill stating that he was responsible to pay his doctor $11,492. He did follow the normal procedure of obtaining pre-approval for the procedure in advance and was shocked when he received this bill in the mail. The BenefitsVIP team called the carrier and reviewed the processing of the claim and found that the claim was paid out of network because the employee had been activated under the incorrect group number. Phillip’s claim of $11,492 was paid with no issues to his credit. |
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| Lori needed an ultrasound due to a large mass that was just discovered, but the radiology group stated that she would have to wait three weeks for the procedure. Lori was so emotional and upset that she called her BenefitsVIP team for some immediate help. BenefitsVIP was able to find a radiology center close to where Lori lived that could see her within 36 hours. BenefitsVIP got the carrier to approve this exception and there was not even an out of pocket copay. |
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Cancer myths
The Myth:
Did you know that 38.7% believe that living in a polluted city is a greater risk for lung cancer than smoking a pack of cigarettes a day.
The Truth:
Breathing polluted air from vehicles, industry and power plants is unhealthy and causes up to 2% of lung cancers; however, if you’re still smoking and think there’s no point in quitting because of pollution, consider that cigarettes are responsible for nearly 90% of all cases of lung cancer. |
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Four easy ways to keep cancer away:
Obesity is a risk factor in six types of cancer, a landmark report recently announced. Consuming alcohol, red meat and processed meats also raises your odds, while eating more fruits and non-starchy vegetables and getting more exercise lowers your risk. Use these research-based tips to jump-start a healthier lifestyle:
- Snack on carrots, red pepper slices
and snap peas during the day while
at your desk.
- Increase the amount of fruit you eat – serve fruit salad instead of a high
fat dessert.
- Mix ground turkey with red meat.
- Skip dessert and go for a nightly walk.
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What are the benefits of a Medical Savings Account (MSA)?
An employer may place funds into an account for the employee to use for their healthcare needs. The employee may:
- Draw on the account to buy healthcare insurance
- Pay policy deductibles, copayments or medical expenses not covered by their health insurance policy
- Periodically withdraw money from the MSA, but there may be tax implications.
The main advantage of an MSA is that you will not pay income taxes on any money put in the account. |
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| Be a Smart Healthcare Benefits Consumer When Scheduling Lab Tests! |
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| While many lab errors are out of your control, there are steps you can take to increase the chances of accurate results. |
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- Ask your doctor about the lab they use. The lab should be accredited and approved by the College of American Pathologists
- If you can see the test tube or slide, double-check that your name is on it
- If you're in the hospital, make sure your wristband is accurate
- If the result of the test is a surprise, ask your doctor: "Did you expect this? Do you think this is what I have?" If the answers are no, consider repeating the test
- Be sure to get a copy of all lab results and reports
- If needed, have a specialist read your slides
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| For certain diseases, false positives or false negatives are common, and some labs routinely have two pathologists read these more challenging slides. Labs may also elect to repeat tests before reporting certain diagnoses, such as HIV or cancer. You also have the right to have your slides reviewed by another pathologist or another hospital, and for a serious diagnosis. Specimens are part of your medical record and you have the right to them. Most insurers will pay for a second opinion. |
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