Meet the Customer Care Team: Johanna!

       We are going to introduce a member of our Customer Care Team each week.  We hope this helps you to get to know us better.  Along with putting a face to a name or voice on the phone.  This week we are introducing: Johanna.

       Johanna has been with the team since June of 2007.  She has become one of our team's greatest assets.  She is currently our Senior Customer Care Representative and handles more of the complicated or escalated issues we receive.  Her wealth of knowledge and expertise in resolving tough claim issues is invaluable to our clients and to McGohan Brabender.  Johanna's passion allows her to really think outside the box and look at claim issues from all angles in order to truly help our members. She resides in Centerville, OH with her husband and son.  Johanna is very active in her church and enjoys spending time with her family.  The Customer Care Team is very lucky to have her.  Say Hello to Johanna!

Help with Reading your Explanation of Benefits

Have you ever received claim information from your insurance company and was so confused you didn’t know what to do?  Well, help is here!

Reading any Explanation of Benefits (EOB) can be challenging for members trying to figure out what is meant and what you actually owe on a claim. Below are three examples from Anthem, United Healthcare and Humana with an easy to understand breakdown on an EOB.  Your days of not understanding your claims can hopefully be behind you!  Of course if you have any questions, you can always call member services on the back of your ID card.  If you are still unsure, McGohan Brabender Customer Care is always here to help!

Guide to Anthem's Explanation of Benefits

Guide to United Healthcare's Explanation of Benefits

Guide to Humana's Explanation of Benefits

Find help with the cost of Medicine

Our team received a “tip” on this site and it was too good not to share!  In our opinion this is one of the best sites found so far!  Below is link to a source of discounts, coupons, and so much more for prescription medication.  This site can help with all ages and even someone without insurance benefits.  We are very excited about finding this website and it is truly worth a look!

NeedyMeds.org

HSA Contribution Limits for 2012

Please see updates for increases in HSA contribution limits for 2012. Remember these amounts include any contribution employees may receive through employer contributions.

New Contribution limits for 2012 with HSA – Health Savings Account 

Individual:  $3,150.00

Family:  $6,250.00

Catch-up Contribution $1,000.00 – 55 years of age and older for 2012.

HSA Qualified Expenses IRS List

Walgreens and Express Scripts Negotiation Update

The negotiations for Walgreens and Express Scripts for their contract renewal continues, however both sides are losing optimism for a favorable outcome as the January 1, 2012 deadline nears.

Recently, Anthem has released the following letters and frequently asked questions regarding what will happen next for their clients who currently use Walgreens Pharmacies:

Anthem Letter to Employers

Anthem Letter to Employees

Anthem FAQ for Walgreens Customers

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!

Update: Express Scripts/Walgreens Negotiations

Express Scripts, the company that administers [Anthem/Empire/UniCare]’s prescription drug Plan has been notified by Walgreens of their intention to leave the network when the contract expires on December 31, 2011.  The parties are still in negotiations and Anthem hopes to have this signed by the end of the year.

We have heard that Walgreens is informing customers of their intention to terminate the relationship at the end of the year with letters.  

Below you will find a Q/A sheet that Anthem has distributed.  Please feel free to use this information as warranted.  As we have more information to share, we will continue to update this blog.

Thank you

Anthem FAQ