http://www.hrbenefitsalert.com/insurance-carriers-dirty-little-secret/ Daily dose of benefits news and know-how Sat, 18 Jun 2011 21:36:33 +0000 hourly 1 http://wordpress.org/?v=abc http://www.hrbenefitsalert.com/insurance-carriers-dirty-little-secret/comment-page-1/#comment-9445 Jeanette Thu, 28 May 2009 21:34:51 +0000 http://www.hrbenefitsalert.com/?p=99#comment-9445 Try getting information about claims paid from the carrier. Auditing is almost impossible as they are only willing to give claims paid in the aggregate. I find it amazing that we pay the bills, they tell us about supposed large claims which exist and which we cannot substantiate. In our company, we know who is ill, has been on leave, etc. and yet there are claims for illnesses which don't seem apply to anyone and which they will not prove. We are paying almost $4MM a year in health insurance and flying blind! Try getting information about claims paid from the carrier. Auditing is almost impossible as they are only willing to give claims paid in the aggregate. I find it amazing that we pay the bills, they tell us about supposed large claims which exist and which we cannot substantiate. In our company, we know who is ill, has been on leave, etc. and yet there are claims for illnesses which don’t seem apply to anyone and which they will not prove. We are paying almost $4MM a year in health insurance and flying blind!

]]> http://www.hrbenefitsalert.com/insurance-carriers-dirty-little-secret/comment-page-1/#comment-9211 njv Tue, 26 May 2009 15:02:25 +0000 http://www.hrbenefitsalert.com/?p=99#comment-9211 I work for an insurance brokerage house and let me tell you this is a big headache for all our clients. Even within one carrier you can have the dependent student coming off at “date of event” (birthday or graduation) on the PPO side and at end of month on the HMO side… but that’s not the end of it. Like you mentioned that’s just on the claims side. On the enrollment (billing) side nobody comes off until the member fulfils their responsibility and notifies the carrier. So you can be getting charged for a dependent yet none of their claims are being paid. You can only go back 90 days in most cases to get credit on the dependent that should have come off the bill. I work for an insurance brokerage house and let me tell you this is a big headache for all our clients.
Even within one carrier you can have the dependent student coming off at “date of event” (birthday or graduation) on the PPO side and at end of month on the HMO side… but that’s not the end of it. Like you mentioned that’s just on the claims side. On the enrollment (billing) side nobody comes off until the member fulfils their responsibility and notifies the carrier. So you can be getting charged for a dependent yet none of their claims are being paid. You can only go back 90 days in most cases to get credit on the dependent that should have come off the bill.

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