Claims Management

Our services are user-friendly. Our clients or their representatives can send all of the client’s paperwork (medical bills, insurance claims, and explanation of benefits (EOB’s). We track their claims and payments by filing and following-up on any outstanding claim discrepancy. Our goal is to identify and collect all monies that are due to our clients from Medicare and private insurance, and from overpayments to providers.

Our service includes verifying policy terms regarding insurance coverage.

Monitor Medicare and “automatic” claims filed with private insurers to ensure that reimbursements are complete and correct.

Gather information from providers, insurance companies and, when necessary, the insured or designated agent.

Determine which bills are not reimbursable (that is, would not be covered under the policy in place.

File claims for medical goods/ services, which should be reimbursed by private insurance, such as a Medicare Supplement policies and the provider’s excess charge.

Evaluate rejections of claims and resolve disputed rejections.

Identify and resubmit improperly denied claims.

Verify receipt of refunds due to the insured from providers who have been overpaid.

Inform when to pay invoices from providers.

Example of how we help:

Problem – Unknown Policies

Caregivers do not always know about the details or even existence of an older adult’s insurance policies. The result can be that valid claims are never filed.

An elderly Medicare beneficiary passed away after a six month illness which had kept her at home receiving informal care from her family and friends. She had a Long-Term Care Insurance policy that paid benefits for informal care, but no claim was ever filed because the caregivers did not know of the policy.

Our Solution: We recognized that the Long-Term Care Insurance policy would have paid benefits to cover the last six-month period if a valid claim had been filed. Working with the decedent’s healthcare provider and the insurance carrier, we were able to reconstruct a valid claim, which the company honored. The estate received $27,300 ($150 per day for 182 days).

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