February 2008


Member Aggravation: Employee called BenefitsVIP requesting assistance with a medical claim indicating he was responsible to pay a provider $11,000.  Employee was extremely upset as he had received the approval for the procedure in advance.

BenefitsVIP Intervention: BenefitsVIP immediately called the carrier and reviewed the processing of the claim with the account manager. It was found that the claim was paid out of network because the employee had been activated under the incorrect group number. Further review showed that several others at the same company were in the wrong group. BenefitsVIP assisted with an eligibility and subsequent claims audit.

Resolution: All employees were put in the correct group number. All outstanding claims were reprocessed and paid correctly.  The $11,000 claim was paid with no member liability.

Client Response: “You just made my week-end. I was trying to figure out a way to tell my wife we have a bill for $11K. Thank you very much!

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BenfitsVIP from Corporate Synergies is a benefits resolution contact center that can help save your employees time by resolving ALL of their benefit inquires efficiently over the phone.   97% of all issues are resolved within 24 hours.

For Your HR Department
  • Reduced administrative burden; we deliver:
  • Detailed reports that log and track issues by type so trends are quickly spotted and addressed
  • Standard reports showing activity as well as ROI
  • Communications handled in compliance with HIPAA privacy regulations
  • Calls answered within seven seconds on average
  • A variety of options to distribute and access this elite program for your organization, from ID cards to the Web
     
For Your Employees
  • Effective, easy to use service so they can get back to work; we resolve:
  • Denied and incorrectly paid claims
  • Coverage/service questions
  • Locating participating physicians
  • Prescription drug coverage/reimbursements
  • Obtaining pre-certifications for medical procedures/prescriptions
  • Dependent eligibility verification
  • ID card replacement
  • Flexible spending account reimbursements
  • …and 97% of these types of issues are resolved within 24 hours

A whopping three quarters of Americans admit to not always taking their prescription medicines as directed, according to a report by the National Council on Patient Information and Education.  By not taking your medicines as their doctor intended will not help you get better and you may even become worse.  This will impact your out of pocket costs and has a direct correlation to your employee benefit costs.  Patients commonly fail to take their medications as directed, leading to unnecessary hospital admissions and even death, costing the health care system as much as $177 billion a year. Patient adherence to any medical treatment program is necessary in order to achieve high-quality and cost-effective health care.  Don’t be embarrassed to ask for clarification and you should not leave the doctor’s office or pharmacy without knowing the answers to the following questions:

  • How severe is my medical problem?
  • What are my goals to control this medical problem?
  • How often do I need to take this medicine?
  • What are the risks if I do not take my medicine as directed?
  • What are the common side effects and what can I do to control these side effects so I can keep taking the medicine?
  • Are there any prescription or over-the-counter medicines or herbal products that I should avoid?
  • What should I do if I forget to take my medicine?
  • How can I get help if I cannot afford my medicine?
  • Can I save money on my co-pay by getting a “splitable” pill?

Be honest with your doctor.  Discuss any allergies or problems you’ve had with a medication before.  Also, give a rundown of all the medication you’re taking – prescription, over-the-counter, and herbal.  Also, smoking cigarettes or drinking alcohol may change the way your medicines work, so inform your doctor on these types of habits.  Give your medications a checkup.  Store your medicines in a cool, dark and dry place, and examine them at least once per year.

  • Look at expiration dates and throw away any medicines past their expiration dates.
  • Throw out medications that have changed color formed a residue or developed a peculiar odor.
  • Throw away any capsules that have opened.
  • Discard any drugs with a missing or unreadable label on the bottle.
  • Never take another person’s prescription.

Is your colleague taking their medicine as prescribed?  Are they getting the preventive care so you don’t have to pay more for your medical benefits? 

While it’s generally true that there is no “free lunch” when it comes to ways to reduce the spiraling cost of the nation’s healthcare, there is one that only costs $4.99. That’s the average price for a pill splitter.

And, the amount of savings that can be realized by using this simple device far outweighs its nominal cost. In fact, for many individuals, this technique has literally halved the cost of prescription drugs – for themselves and for their employer. So successful is the pill splitting strategy in generating dramatic cost savings that many of the country’s largest and most influential benefit carriers have begun to require the use of the device for specific medications. Kaiser, Humana and UnitedHealth have each unveiled such a program and others, including many state public health programs, are rapidly following suit. Should you?

For many of the most commonly prescribed medications, the cost of the double strength dosage is frequently less than 20% more expensive than the standard dose. And, often, the costs are identical. If that medication is “splittable” (meaning: is it in tablet form that can be effectively divided into two equal halves), the logic of the strategy is unassailable – two-for-the-price-of-one! Moreover, the savings are realized by  the employee by paying only one-half of their normal Rx co-pay.

That’s the very definition of a win-win!How much can be saved under a pill splitting program? Participants in the United Healthcare study saved as much as $300 per year in co-pays alone. In a frequently cited study at Stanford University, the savings amounted to an average overall savings of 36% in the cost of the drugs dispensed.  

We know that staying well involves more than just visits to the doctor’s office – it is important to plan for these visits.  On average doctors only spend about 15 minutes with their patients and to truly make the most of this time together a patient needs to prepare using the following guidelines. Nothing matters more to you than staying healthy and keeping your loved ones healthy, too.  Navigating America’s complex health system can leave you anxious when you need to sign a consent form, agree to a medical test or visit a doctor.  Here are some tools you need to become a more able, skilled and confident manager of your family’s health.    To get the most out of your next doctor’s visit, follow this insight:

    1. Prior to the doctor’s visit write down the following:
      • Make a list of prescription drugs as well as any over-the-counter medicines or herbal medications you have been taking.
      • Bring copies of your latest test results from other specialists you have seen.
      • Include other specialist contact information.
      • Write down your medical history as well as your family’s medical history.  Your doctor needs to know about any previous hospitalizations, as well as current medical problems.
      • If you have diabetes record your daily blood-sugar measurement and bring along your log.
      • If you have high-blood pressure get a series of reading at home during the week prior to your visit
    2. Two day prior:
      • Call your doctor’s office to see if you should skip breakfast or lunch if you are having blood tests.
      • If your condition is complicated or you are trying to make a serious decision about your health, consider bringing along a family member or friend to your appointment.
    3. The doctor’s visit:
      • Show up a few minutes early and be prepared to complete some forms.
      • Start with your most urgent question and be prepared to talk about symptoms.
      • Feel free to ask questions if you do not understand what your doctor is saying. 
    •  
      • Prior to leaving make your next appointment.
      • If the doctor prescribed medications, get them filled and start taking them as prescribed.

Welcome to our “My Health Empowerment” blog. We want to use this great medium to establish a more direct communication with our clients, prospects and partners, creating even more of a dynamic relationship.  We make it our business to keep you connected to benefit and health management issues that shape your lives every day.

Stay connected as we bring you topical benefit news, success stories, relevant articles and more. Our goal is to give you a health and benefit financial management advantage – no better way to do this than via timely and topical information that is written here on this blog to keep you connected on strategies and techniques to enhance your personal wellbeing.  As always, we welcome and look forward to your input.