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How To Process Your Health Care Claims Without Giving Yourself A Headache

April 24, 2017

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We spoke with Martha Bradt, the owner of Health Claims Concierge LLC, a company that helps people file and track their health insurance bills to understand how claims assistance professionals like her are helping people keep their health insurance paperwork under control:

Tell us about your company, Health Claims Concierge LLC.

In 2012, Health Claims Concierge LLC launched with two clients. They were busy families seeing some out of network providers. Their un-filed and denied claims meant money owed to them by their health insurance was being left on the table. They were losing money that their policies would reimburse if the claims were submitted correctly, tracked, and followed when necessary. Today, both families still use Health Claims Concierge, in addition to over 70 other clients over the last five years.

What type of people are coming to you for help?

The core business tends to be families with young children. Several busy, single working women have also hired Health Claims Concierge. Frequently, we take over from executive assistants who need to do their real job instead of doing the boss’s health claims. Special situations — a big surgery or incorrectly processed in-network claims – has resulted in business. In a few cases, we have literally “helped” marriages survive by making the family health claim mess disappear. Checks start coming from correctly processed claims and everyone is much happier.

How do you save your clients time?

The reality is, Health Claims Concierge saves clients time and “makes” money for them by getting their claims processed correctly. The client saves hours of health claim headaches chasing money that is owed to him or her. One client said before he hired me he had told a healthcare agent over the phone, “I need therapy, because of these health claim hassles and the stress they cause!”

Health Claims Concierge files claims, follows up on problem claims, facilitates direct deposit, calls providers if medical records are required by the insurance company, calls in-network doctors/labs/radiology companies with the correct insurance information if that has not been provided by the patient among other client services.

Importantly, by verifying that a claim has all of the information (coding, tax ID, etc.) that the insurance company requires BEFORE the claim is sent in, we save the client time s/he would spend chasing a denied claim.

How do you organize file and track someone’s claims?

It’s very simple – by person, by date of service. The process is:
– Client sees the out of network doctor and pays at the time of the visit.
– Paperwork is sent to HCC by the client, or by the doctor, in a self-addressed, postage paid envelope or by email.
– HCC files the claim electronically to the patient’s insurance company resulting in faster, more accurate processing of the claim. This also takes less billable time than sending paper claims.
– HCC tracks the claim online (UHC, Aetna, and Empire/Blue Cross plans process routine claims in 24-48 hours. Behavioral health claims usually take longer.)
– HCC verifies the claim was processed correctly. If not, according to the error code on the claim, HCC follows up with the provider or carrier as necessary to get the claim processed.
– HCC files all processed claims in historical files by person, by date of service.

Can you give an example of a claim reimbursement problem you were able to help resolve?

Here are two examples:

The PT EOB (Physical Therapy Explanation of Benefits) says “need more information” for six $100 out of network visits. I call the PT office, fax the EOB to the PT office (yes fax ….HIPAA keeps the fax business alive) so the PT office can send the medical records to the insurance company. This claim was re-processed; the patient was reimbursed $540 of the $600 she had paid ($90/visit.)

Recently, I helped a Park Avenue psychiatrist correctly re-code a young woman’s visits — instead of receiving $150 for a $400/visit — over 10 visits — the patient received $280/visit. That is an additional $1300 insurance benefit to which the patient was entitled for the services rendered by the doctor. The doctor is not a coding expert, nor is the patient.

How can people give you permission to access their health insurance claims and websites? Does this ever become an issue when helping someone with a claim?

This has never been an issue. Logging onto a client’s personal insurance account is by far the most efficient way to track claims and message with the carrier regarding specific claims. Clients give Health Claims Concierge permission to do this in their contract with HCC.

HIPAA authorizations to receive Private Health Information (PHI) from providers that might help get a claim processed should be required by every medical office before releasing information to Health Claims Concierge. The reality is only large hospitals, some lab companies, and large physician practices require this paperwork.

What is the average amount of money you save for your users each
year?

If you never filed your claims, or you never followed up on denied claims, then Health Claims Concierge “makes” money for you according to your plan. HCC secures the reimbursements to which you are entitled based on your policy. Plan deductibles vary; there is no average amount of money saved or made.

What sites and resources do you recommend people turn to for more information on this subject?

Fundamentally, you will be surprised about what you can learn about your own insurance policy, deductibles, and general insurance lexicon by logging into your own insurance account and spending time there.

If you would like to hire a service like Health Claims Concierge LLC, go to www.claims.org and click Find A CAP (Claims Assistance Professional.) Most CAPs work across state lines. To file someone’s health insurance claims and/or advise you on your health insurance, state licensure is required in NY, CT, MA, VA, FL, and ME and probably many other states. As of this writing, my understanding is a license is not required in NJ, DC, or CA.

Author

Catherine Sharick

The former head of TIME.com and now a work from home mom with three kids, Cathy knows how to manage a house and career. She’s currently consulting for early stage startups and leading content at JOYST where she is helping women take back time for themselves.