FAQs
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When it comes to benefits, we know you have questions. Our knowledgeable staff has been extensively trained to help you answer all questions and can educate your employees with issues regarding benefits.
Q. I've had lifestyle changes, how does that impact my benefits?
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You will want to let your HR coordinator know of any lifestyle changes and you will need to complete an enrollment/change form. This way, HR can submit the enrollment/term/name change to us at Bond Financial. Several lifestyle changes are recognized as qualifying events that would dramatically change your health insurance needs and will allow you to change the status of your medical coverage outside of your standard open enrollment period.
Common Qualifying Events
• Marriage
• Divorce
• Birth of a child
• Spouse's loss of employment
• Death of a dependent
• Adoption
Time Limit
Generally, you must report the qualifying event to your insurance company and make any necessary changes within 30 days of the event.
Changes in Premiums
Premium changes will typically be made retroactively. That is, to the date the event occurred. You may be responsible for any unpaid changes in premiums between the occurrence date and the date you reported the qualifying event.
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Q. Which benefits plan is right for me?
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Assess your needs, taking into account your current use of health care and your medical expenses for the near future, and decide what services are most important to you and your family. Ask about dependents' coverage. Factor in how much you can afford to spend on monthly premiums and co-payments. If you're single and healthy, your health plan needs will be very different from those of a family with three young children.
Compare benefits and coverage of key items such as:
- Monthly premiums
- Deductibles
- Co-payments
- Co-insurance rates/costs for seeing out-of-network providers
- Preventive care
- Physical exams
- Immunizations
Q. Why was my claim denied?
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You can appeal claims denied by your medical insurance provider. It will take familiarizing yourself with the facts, and staying on task.
1. Read your policy
This is the most important thing to do, and it should be done first. Having a firm grasp on what your insurance policy says about your coverage will help you appeal a denied insurance claim.
2. Get help
If you are having problems understanding the fine print, either call the insurance company directly or talk to your benefits representative if it is a policy through your employer. Remember, you can also always call Bond Financial for assistance in navigating the process.
3. Gather Information
Call and get all of the information from the insurance company regarding what you will need to appeal the claim. Make sure to document who you spoke with, write down every step and record all pertinent information.
4. Write a letter
With all of the information you have gathered, send a letter to the insurance company stating that you would like to appeal your denied claim. Be sure to include copies of all medical bills, documents required for the appeal and records of the steps you have taken before writing the letter.
5. Keep track of the appeal process
Some larger companies can take weeks, even months, to process your appeal. Continually call and check up on the progress with the insurance company.
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Q. I received a provider bill or EOB I don't understand
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1. Find the Claim Summary section on the EOB.
The subscriber is the primary person eligible for benefits. The patient, who is receiving the services, can be the subscriber or a dependent. The group name and number identify the specific plan under which the subscriber is covered.
Each service or visit has its own unique claim number to help with tracking of the individual claim. The provider is where, or from whom, the services were rendered (e.g. name of doctor, clinic or laboratory). Covered medical supplies are also included on EOB forms.
2. Find the payment summary section.
Dollar amounts are listed for charges submitted to the insurance company and for out-of-pocket costs. Examples of out-of-pocket costs include the deductible, coinsurance and copay, all of which are also known as the patient responsibility.
The deductible is the amount of money a consumer needs to spend before the insurance company starts paying benefits. (Example: The deductible for Mary's plan is $300 per year. Mary needs to spend $300 of her own money before the insurance will start paying for other covered services).
The copay is a flat fee designated by the insurance company that the patient pays for certain services, such as office visits or prescriptions.
The coinsurance amount includes charges for services not covered at 100 percent. The patient responsibility (coinsurance, copays, or deductible amounts) is the amount a provider may bill the patient after all payments and deductions are made on the claim. Payment would be made directly to the provider, not through the insurance company.
3. Find the Claim Details section.
Each claim has a corresponding type and place of service, as well as a specific date when the service was provided.
The amount a provider billed to the insurance company is often known as the charged amount. Each insurance company also has an allowed amount, which is the maximum they will pay for a particular service. (Example: the clinic billed $100 for a standard office visit, but the insurance company only pays up to $75 for that type of service).
Some insurance companies also list the percentage covered for that type of service. (Example: X-rays covered at 100 percent, and wheelchair rental at 80 percent. The insurance company pays the provider 100 percent of the x-ray charge and for most, but not all, of the wheelchair rental charge).
Tips & Warnings
- If there is anything on your EOB that you don't understand, contact your insurance company.
- If the charge is non-covered or was not paid due to a lack of documentation, you are usually not responsible for the charge.
- Save all EOBs for at least one year.
- File all EOBs with the corresponding statement you receive from your doctor.
Q. I called the insurance company and they couldn't help me.
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Call Bond Financial and ask for the help of your Account Manager and Healthcare Coordinator to guide you in the right direction.
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