Your Right To Appeal

Health care and the processing of claim is not a perfected science. Claims get coded incorrectly by providers’ offices, sent with incorrect ID information, or processed incorrectly through benefit plans. For health care consumers, it can take some digging and effort in order to get these matters corrected. Sometimes, it even takes an appeal (or multiple appeals).

Based on a recent article by Money Magazine:

·         15% of health claims are denied

·         14% of denied claims are appealed

·         50% of appeals are successful

As patient advocates for our clients, the McGohan Brabender Customer Care Team acts as the patient advocate – mentioned in section 4 – to help identify errors, craft appeals, and escalate the battle when necessary.

Make sure to check out Money Magazine’s article for more information on your right to appeal!

Anthem's Radiology Shopper Program

Recently, Anthem launched a new Radiology Imaging Shopper Program for the following counties in Ohio:

Belmont, Butler, Carroll, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Delaware, Erie, Fairfield, Franklin, Fulton, Geaga, Greene, Hamilton, Hancock, Holmes, Huron, Jefferson, Lake, Licking, Lorain, Lucas, Madiosn, Mahoning, Medina, Miami, Montgomery, Muskingum, Pickaway, Portage, Richland, Ross, Stark, Summit, Trumbull, Tuscarawas, Union, Warren, and Wood.

With this tool, members can compare costs for the same procedure at multiple locations in their area. For more information on this program and how if can help to keep your health costs down, check out this flier from Anthem!

New Women's Preventive Services

Recently it was announced that the Affordable Care Act has been expanded to include additional prevention coverage for women's health and well being. Under the act, originally signed into law in March 2010, it is required that health plans cover preventive services without cost share, such as copays or coinsurance, when going to an in network provider. Coverage included preventive services like mammograms, colonoscopies, and immunizations.

On August 1, 2011, the Affordable Care Act was expanded to include well-woman visits, screening for gestational daibetes, HPV testing, counseling for STIs, counseling and screening for HIV, contraceptive methods and counseling (except when group exclusions apply), breast feeding support/counseling and supplies, and screening and counseling for interpersonal and domestic violence. For an outline of the guidelines, check out the US Department of Health and Human Services site.

Please note that these guideline are effective August 1, 2011, but non-grandfathered plan and issuers are not required to provider coverage without cost sharing consistent with the guidelines of the act until the first plan year that begins on or after August 1, 2012. As always, it is beneficial to contact your member services line with your insurance carrier to verify what all is covered (and how it will pay!) under your benefit plan.