Anthem Changes Zosatavax Coverage

After receiving FDA approved information, Anthem has updated its policy regarding coverage for Zostavax immunization. Previously, Anthem had only covered this immunization for members age 60 and over. However, they have now decided to offer coverage for this immunization for members ages 50 and over.

Should a member decide to get this immunization, they should be aware that few physician offices have this to offer, and most members will need to go to pharmacies. However, few pharmacies are authorized to submit medical claims and this immunization cannot be run as a prescription. Therefore, most members will need to submit an Anthem Medical Claim Form in order to receive their benefits and reimburnsement for this immunization.

Tour Your United Healthcare eServices site!

Utilizing employer eServices sites can be a wonderful tool for HR Administrators. With just a few clicks of your mouse, you can have the ability to enroll new hires, order ID cards, and ensure that your employees' benefits are processed in real time!

Although this option can be a blessing for many administrators, sometimes the systems can be difficult or confusing to navigate at first. Thankfully, United Healthcare is one of the carriers that has been proactive in ensuring that groups feel comfortable using their eServices websites.

If you would like to take a guided tour or use an interactive site demo, United Healthcare has created these options to ensure that your can confidently utilize the eService site. We have even added a link to the guided tour on our video tutorial page for you to go back to should you ever need a refresher!

Closing an HSA account

HSA accounts are a wonderful tool for member with high deductible plans. They allow members to save tax free money to contribute towards their healthcare costs and can help them to keep track of their deductibles.

It is important to remember that HSAs are bank accounts, though. Just like a bank account, no one other than the account holder can make changes or requests for this account. So should the account holder run out of funds or switch to a PPO plan and decide to close the account to avoid any monthly fees, etc., the member must call and make this request themselves.

Should you need to make changes to your HSA account, you can contact your bank with the following information:

Fifth Third HSA
for support: 888.350.5353

ACS | Mellon Bank
for support: 877.472.4200
after hours support: 800.264.5578

Trends in Benefits: HPV Testing Not Covered as Preventive

Healthcare reform has brought on many changes to the healthcare industry, and one of the benefits that has brought about significant confusion has been the coverage of preventive services in full.

Recently, our team has begun to see a trend of charges for women going for their annual exam with their OB/GYN. Upon investigation, everything has been coded as preventive for many of these exams, but the charges are coming from the lab. Though most of the labs run are coded and can be run through benefits as preventive, HPV screenings are not on the approved list for preventive coverage and are therefore not covered in full. Thus, members are finding that their exams, which they believed would be covered in full, are having some charges. We have seen this happen with multiple carriers, especially as physcians are beginning to make this screening a part of their protocol for annual exams.

So long as this screening remains off of the list of codes that must be covered in full for preventive services and physicians continue to make this a part of their protocol, members will most likely continue to see this charge during their annual exam.

UPDATE: Please see our article on new women's preventative services

How can you be sure that a medical procedure will be covered by your insurance?

When it comes to a health plan, the specifics can seem complicated and overwhelming. If you are considering a service and want to ensure that it is covered, it is important to take a few steps.

First, check your certificate of coverage that you received after you were first enrolled with the carrier. A good place to start is in the exclusions section. This portion of your certificate will spell out any service that is specifically excluded from coverage. You can also contact the carrier with the number on the back of your ID card. Their representatives are often able to check your certificate for you.

Next, if you are not comfortable with a response that you have received from the carrier and would like to receive additional varification, you can ask your provider for diagnosis and procedure codes. Once you have these, our team is able to check with our dedicated representatives to see if those procedures would be covered by your plan and if you would need a pre-authorization.

It is important to note that while our team is able to verify if your procedures codes would be covered with your diagnosis codes, sometimes it is necessary for a provider to bill additional or different codes, which may not process as you had expected the verified codes to process. However, it is always a good idea to be as proactive as you are able to be and check what codes your provider is able to project before your procedure.

What should you do if your deductible, EOB, etc. does not match up with your HSA?

HSA accounts can be a great way to plan and pay for your medical expenses throughout the year. By offering you a tax-free option to pay for medical bills, prescriptions, and other qualifying expenses, you can get more out of your health care money.

Some individuals set up their plans so that they can cover the cost of their deductible with their HSA money. However, when their EOB and HSA balance do not match up or they run out of money before they meet their deductible, they are upset and confused. If you come across this situation, you will want to: