FAQ: I have exhausted all appeals options through my insurance carrier. Is there anything else that I can do?

Medical benefits are not an exact science, and sometimes it is necessary to appeal the processing of your claims with your insurance carrier. Should you receive a denial to your claim from your insurance carrier, exhaust all appeals processes with you insurance carrier, and still believe that your claim should be reprocessed, you are able to appeal through your state’s department of insurance.

The Ohio Department of Insurance is able to provider consumer information and can investigate complaints involving insurance companies and agents. As noted on their site, the department cannot:

·         Act as your legal representative, or give you legal advice

·         Recommend insurance companies or HMOs

·         Force a company to give you what you want if no laws have been broken

·         Make determinations about medical necessity

·         Address problems with your employer's self-funded health plan, unless the plan involves an insurance company, an HMO or an independent administrator that is licensed with the Department

If you have exhausted your appeals process with your insurance carrier and choose to appeal through the Ohio Department of Insurance, you can do so by completing the following complaint form and submitting it per the instructions provided by the ODI.

Consumer Complaint Form

Pregnant? Check out United Healthcare's Healthy Pregnancy Program!

Pregnancy can be one of the most exciting time of a woman’s – and couple’s – life. At the same time, it can also be a time full of questions, concerns and confusion regarding medical care, the options available, and what steps should be taken to ensure a healthy baby and mother.

In order to make this process easier, United Healthcare has created a site healthy-pregnancy.com that can be accessed by anyone as well as a program for expectant mothers on their plan.

At healthy-pregnancy.com, you can utilize tools such as a due date calculator, week by week baby growth explanations, fitness and nutritional tips, descriptions of the types of delivery available to women, and resources such as an appointment tracker and links to sites that can help you know more about the care your planned hospital offers. Make sure to check out the birth plan checklist (which is printable) so that you can easily communicate your birth plan to your entire labor and delivery team.

The program that United Healthcare has created also provides additional resources to their members. By enrolling for the Healthy Pregnancy Program during the first 33 weeks of their pregnancy, expectant mothers are given access to 24-hour toll-free access to experienced pregnancy and childbirth nurses, educational materials and resources, as well as one-on-one support. Currently, over 41,500 high-risk pregnancies has been identified and supported by the nurses of this program, helping expectant mothers to be more informed throughout their pregnancy.

Top 10 Reasons Your HSA Does Not Match Your Deductible #10

10. Your employer contributions are prorated or you have not yet received the full year’s funds.

Some employer offer to fund part or all of their employee’s HSA accounts each year. Based on this funding, employees sometimes expect that so long as they contribute enough at the beginning of the year to make up the difference between their employer contribution to their HSA and their deductible, they will have met their deductible as soon as their HSA funds have been depleted. However, some employers prorate their HSA contributions or contribute it in equal installments throughout the year creating discrepancies.

For instance, let’s say that an employee is hired July 1^st and their benefits go into effect on their date of hire. They have an HDHP with a calendar year deductible of $3000. Their employer contributes $3000 per year to each employee’s HSA account, but this amount is prorated based on the date of hire. This employee would then receive $1500 to their HSA, but they would still be responsible for an additional $1500 out-of pocket in order to meet their deductible. That member would then receive the full $3000 the next year.

Should the employer make their contributions in equal installments throughout the year, employees might also find discrepancies in their HSA. For instance, let’s say that an employee has a HDHP with a calendar year deductible of $3000 and their employer contributes $1200 in equal monthly installments throughout the year. At the beginning of the year, that employee contributes $1800 to their HSA so that they will have $3000 in their HSA by the end of the year. However, should the employer meet their deductible by June, they will be short $600 from their HSA to pay their bills since their employer has only contributed $600 year to date. Although their employer will contribute the additional $600 to their account by the end of the year, they will not have the remaining $600 in their account until December.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Top 10 Reasons Your HSA Does Not Match Your Deductible

Health Savings Accounts (or HSAs) can be a wonderful - but at times confusing - way to address costs with high deductible health plans. Often, members find themselves trying to reconcile discrepencies when their deductibles and and HSA funds do not match up.

Our team has created an HSA Tracker to help with the process of reconciling, but when discrepencies are found, the next step is trying to figure out why. In order to help make this process easier, our team will be posting shorts blogs discussing the top 10 reasons that HSAs do not match up with deductibles over the next few weeks. If you find yourself trying to reconcile your HSA and want to figure out the root cause of the issue, you can use our checklist of the Top 10 Reasons You HSA Does Not Match Your Deductible to help figure out where the issue is coming from. Think you've found the reason? Check out our blogposts explaining how each of these reasons can create uneven balances:

10. Your employer contributions are prorated or you have not yet received the full year’s funds.

9. Your HSA account has maintenance fees assessed

8. Some of your claims were adjusted after you paid the bills

7. You went to an out of network provider

6.  You paid for non-covered benefits with your funds

5. You paid for vision or dental claims with your funds.

4. You paid for prior year claims with this year's funds

3. You put a deposit down for a procedure and are owed money back.

2. Your medical claims have not been submitted to your insurance.

1. Your prescriptions have not been submitted to your insurance.

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!

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:

Price Your Prescriptions!

When it comes to health care costs, no one wants a surprise. We can do our best to control costs by going to in network providers, understanding any exclusions on our plan coverage, and having our preventive screenings. Now, through your Anthem.com log in, you can price out your prescription medicine!

FAQ : How does the new dependent age extension work?

As the face of healthcare continues to change, many questions arise regarding the specifications those changes. The dependent age extension has brought up many questions from employers, employees, and dependents, so we have attempted to make an easy overview guide to answer those questions.

Keeping Track of Group Plan Information

Sometimes the amount of information that a plan administrator is responsible to keep track of is overwhelming. Just like your personal benefits information, there can be multiple carriers, groups numbers, policy details, and contact information, all of which are essential to organize so that your group's plans can operate properly.

In order to help simplify this process for you, we have created a worksheet where you can input all pertinent information including:

HIPAA FAQ #2: How long is my HIPAA form good for?

Having insurance coverage is a wonderful thing, especially when your coverage works properly. However, sometimes issues do arise, and it is necessary for the McGohan Brabender Customer Care Team to step in and work as the advocate for the member. When this happens and the employee would prefer that we follow up with their fully insured group administrator instead of directly with them, we are required by law to have a signed HIPAA form.

In order to make this process easier, an employee can opt to sign a HIPAA form that allows their group administrator to receive information regarding their coverage and claims for an entire calendar year. In order to do so, the employee needs to:

Fax Cover Sheet

When you have problems with your benefits, it seems as though there are a million little details to keep track of: which doctor did I see? what day did I visit their office? what were the charges? what is my account number? So when it comes time to contact the McGohan Brabender Customer Care Team, it is hard to know what information to have ready to share.

In order to simplify and expedite the process for you, we have created a fax cover sheet that you can fill out and send in along with any statements from your provider or carrier so that we can get to work on your issue. You may even use this form to collect all of the information we will need to get from you before you call in! Having all of this information together can greatly expedite the turnaround time for you and help our team to better serve you.

Want to utilize this helpful tool? Download it here:

HIPAA Form

One of our roles as the McGohan Brabender Customer Care Team is to act as your advocate to carriers and providers, ensuring that benefit plans operate properly. Our knowledge of healthcare as well as our relationship with carriers allows our team to troubleshoot when issues arise, and our commitment to providing the best customer service experience to help members resolve their claims. We always are happy to work directly with the member to resolve claim issues; however, if the person would prefer that we work through someone other than the employee, we require a HIPAA release form.

Tracking Your HSA

Just as Healthcare has seen unprecedented changes in the past year, so have the types of benefits offered to employees. HSAs (or Health Savings Accounts) have become a more popular option for many members, with the tax free dollars offering more bang for your buck as you pay for your medical care. This departure from traditional insurance plans has created a more complex responsibility for the individual, though. Keeping track of where the dollars from your HSA are spent and what they are spent on is crucial for tax purposes as well as reconciling your account.

In order to help make this process easier, we have created a downloadable HSA tracker to input your expenses as you go. As you enter your contributions and transactions from your account, the balance automatically updates. Other tabs include spaces for you to input your important HSA information, a list of qualified and non-qualified expenses, and a sample of how to use the HSA tracker.

Click the following link to download your own tracker!

Keeping Track of Important Benefits Information

Not long after you sign up for your benefits plan, it seems like you are bombarded with information and cards. You might have different carriers for your medical, vision, dental, and life, each with their own cards, ID numbers, and contact information. If you are anything like me, you will most likely misplace one or all of these at least once throughout the year (and usually when you need it the most).

After years of scrambling to find all of my important plan information when I needed it, I decided to input it all into a document and save it to my computer. This way, even when I could not find my card, I would have all of the pertinent information for my benefits in one place.

Think this tool might be helpful for you too? Try a set up like this: