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Acadia Benefits Inc. Blog

  • Tips From Paula: ACA Guidelines

    Posted on February 12, 2019

    As most of us know, the passage of the Affordable Care Act (ACA) in 2010 has provided extensive coverage for routine and screening health care charges.  But many people are not aware of some of the additional services covered under this Act.  Some examples of covered services also include:

    It is important that we educate ourselves on what is covered under the Act.  If a provider codes this type of visit incorrectly, some patients may end up paying a bill that they are actually not responsible for.

    A full list of covered services can be found at:


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  • Kung Pao Chicken! Something with just enough spice to counteract these cold nights.

    Posted on January 31, 2019

    #healthyeating #acadiabenefits #cookinglight

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  • Tips from Paula: New Patient Visits

    Posted on December 27, 2018


    I have had many calls lately from patients who are questioning charges for what they thought was a routine physical.  As we know, under the Affordable Care Act (ACA), routine physicals are covered in full, as long as they are coded as such.

    Therefore, if someone books a routine exam with a new (to them) physician, they are assuming this will be paid in full under the ACA. However, many doctors are starting to add a separate code for the “new patient visit”.  This is because these types of appointments tend to take a little longer than a routine exam, in that the physician is getting to know the patient, the family history, medical background, etc.  The new patient visits are a separate code from the annual exam, and will usually be applied to the member’s deductible, pulling cost sharing for the patient.

    If one is booking a routine exam with a new physician, they should be prepared to possibly receive a separate bill for those services, unless their out of pocket charges for the year have been met.

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  • Welcome Brittany!

    Posted on December 10, 2018

    Acadia Benefits is excited to announce the addition of Brittany Baumann to our team as our Administrative/Marketing Assistant.


    Why did you join the Acadia Benefits Team?

    “After college I worked in several different jobs in the health care field. While in those roles I realized I had a real ‘nack’ for administrative work and found I really enjoyed supporting my colleagues and our customers. I was excited to find Acadia Benefits and I knew right away they value their employees and customers.  Everyone has been very welcoming and I look forward to growing professionally and personally with the team!”

    What do you enjoy doing outside of work?

    “I have recently taken up a love of camping and exploring with my family. This past summer we took our first trip up to Acadia National Park. While at home I enjoy hand sewing and embroidery. My husband and I are huge hockey fans. We enjoying going to the local Maine Mariners as well as the Boston Bruin games.  We are slowly introducing our daughter to our love of hockey. One of our favorite activities is to have family movie night at home with our two cuddly dogs!”



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  • Chicken Stew

    Posted on November 29, 2018

    Chicken Stew

    Recipe provided by Vicki Ferentz


    With the cold weather upon us (welcome snovember!) I have been making this Cooking Light recipe for my family (link below).

    I enjoy this because it can be modified in a variety of ways including:

    • Dairy free – try it with chicken broth instead of milk
    • Add other veggies you have – I add Brussel sprouts towards the end of cooking (so they didn’t get too mushy!)
    • I use a mixture of chicken thighs and boneless breasts
    • Serve with rice or quinoa on the side

    Happy Cooking!

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  • Welcome Catherine!

    Posted on September 27, 2018

    Acadia Benefits is excited to announce the addition of Catherine Desrochers to our team as a Large Group Account Manager. Catherine brings over 15 years of experience in the employee benefits field having worked on both the carrier and brokerage side of the industry.

    Why did you join the Acadia Benefits Team?
    “I have long admired Acadia Benefits and their reputation has always been superior. In a world of constant change, it is impressive not only how many long- term customers they have, but also how long most employees have been there. They are clearly doing many things right and I am honored to be a part of that.”

    What do you enjoy doing outside of work?
    “I love to cook and entertain, so to ‘balance the effects of that’ I enjoy many physical activities, especially jogging with my dog and cardio kickboxing…I even have my own boxing gloves! My husband, two kids and I do a lot as a family, whether that be activities outside (skiing, hiking, time on the lake) or just relaxing and watching a movie.”


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  • Summer Gazpacho Recipe

    Posted on September 5, 2018

    Summer Gazpacho

    Recipe provided by Sara Pinto


    This gazpacho recipe is something I have “cooked” for many years and be warned… It makes a lot!  So invite your friends over on a hot night and enjoy.  It requires some chopping and stirring (it’s easy) and you can serve as an appetizer or main dish (it’s versatile).  Serve cold with avocado and tortilla chips.



    1 red onion

    4 garlic cloves

    1 European cucumber, seeds removed

    5 plum tomatoes

    2 red peppers, seeds and core removed

    3 cups tomato juice

    1/4 cup olive oil

    1/4 cup vinegar (white or white wine will work best)

    1/2 tablespoon salt

    1 teaspoon black pepper


    Roughly chop all vegetables.  Pulse each vegetable individually in a food processor or finely chop by hand into small, bite size pieces.  Add all vegetables to a large bowl with tomato juice, olive oil, vinegar, salt and pepper.  Stir, cover and refrigerate for a minimum of 12 hours.


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  • Out-of-Network Ancillary Surgical Charges

    Posted on August 14, 2018

    When we are about to have surgery at a hospital or outpatient surgical center, we usually check for network status of the facility and surgeon, to be sure we are getting the best benefit for that service.  As we know, staying within the network of our plan will result in lower cost sharing for us.

    It is important to remember that some services during that surgery may be performed by an out-of-network  “ancillary” provider.  Examples may be anesthesia, imaging, and lab, to name a few.  When the claims are processed for those providers, we may end up with a balance bill that has been applied to out-of-network deductibles, vs. the in-network benefit. This can mean a difference in several hundred dollars in bills for the patient.

    We advise our customers to review these bills when they come in, and always call the insurance company to see how they were processed. Obviously, patients have no control over who performs these ancillary charges, and therefore, should not be penalized with higher out- of- pocket costs as a result.

    Our employee advocate service is available to help with these types of issues, if the insurance company is not willing to adjust the claim.  We have a very high success rate on appeals for out-of-network ancillary charges. Customers should always double check surgical bills, and challenge them if something doesn’t appear to be correct.

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  • Tips From Paula: Setting Up An Online Account

    Posted on May 9, 2018

    One of the easiest and most efficient ways of tracking your insurance claims and other activity is by setting up an online account.

    Most, if not all, insurance carriers, now have an online portal available.  This gives members the ability to perform many simple tasks, such as viewing and tracking claims, downloading  forms, looking up a drug, ordering a new ID card, and selecting a new PCP.  One of the most important tools is the “deductible tracker”.  This is very helpful for those who want to know where they and their family members stand in their deductible costs so far for the year.

    We strongly recommend using the online accounts as a way to manage your health and utilize the carriers’ resources.  If you are unsure about how to set up an online account, you may call the member services number on your ID card, and a representative will assist you in that process.

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  • Tips from Paula: Understanding Balance Billing

    Posted on March 5, 2018

    As Employee Advocate here at Acadia Benefits, I spend a good deal of time helping our customers understand their bills from providers.  It is often confusing and hard to understand these statements.  The first thing we look for on a bill is some sort of reference to a payment or reduction from the insurance company.  This means that the bill has been correctly submitted to the insurance company. If there is no reference at all to this type of activity, there is a good chance that it was either submitted incorrectly (perhaps to an old policy) or not submitted at all.  If still not sure, we recommend that patients compare these statements to their insurance company’s Explanation of Benefits (EOBs) to see if the processing and payments line up.  If there is no record of a claim in the EOBs or in the online account, then the patient should call the provider to be sure the claim was actually submitted, and if not, to be sure they have updated ID card information so the claim can be sent ASAP. There is also a matter of “timely filing”, i.e., there are often time limits placed on how long a provider can wait before submitting a bill, so time is of the essence in these matters.

    In addition, it is extremely important not to pay a bill unless you can confirm that you are not being billed beyond the applicable copay or contracted amount.  Contracted providers should not be billing the patient for the full charge of the visit.  Cross-referencing the EOBs can quickly show if the provider is billing you correctly.

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