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Acadia Benefits Inc. Blog

  • 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.

     

    Ingredients

    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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  • Tips From Paula: Coordination of Benefits Letter

    Posted on January 23, 2018

    Occasionally,  two insurance plans work together to pay claims for the same person. That process is called coordination of benefits. Insurance companies coordinate benefits to avoid duplicate payments by making sure the two plans don’t pay more than the total amount of the claim. They may also need to establish which plan is primary and which plan is secondary—the plan that pays first and the plan that pays any remaining balance after your share of the costs is deducted.

    The carriers will periodically send out letters to the insured, to check on “other insurance coverage”, especially if certain claims appear to be part of an accident, such as a broken leg, hip injury, etc.  If the insured ignores the letter, eventually the claims will be pended, and not processed.  Eventually, these claims may be sent to a collection agency, and it may take several months,  or even a year before the insured receives the collection notice.

    Since it can be difficult to get the claims processed and paid after that amount of time, we strongly recommend that insureds answer these letters or questionnaires as soon as they are received. Many times, the insurance company will take the information right over the phone.  Once they know there is no other insurance coverage on the claim, the claim can be quickly processed and paid.

     

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  • Tips From Paula: Obtaining Medical Records for Disability Claims

    Posted on August 7, 2017

    I have been very busy this summer working on our customers’ disability claims! One recurring issue I have come across is obtaining medical records for the insurance companies’ review.

    Most large medical practices now “outsource” their medical records distribution to a third party.  These third parties usually want payment for their time and resources.  The process can be extremely time consuming, often resulting in long delays before claimants will receive their disability checks.

    The process begins with the insurance company sending a request for records to the physician’s office, who in turn, sends the request to their third party medical records company.  That company then sends a payment request to the insurance company, who must cut a check and mail it back to them before the records can be pulled and mailed.

    This whole process can take up to 3 or 4 weeks, depending on how quickly each responsible party turns the requests around.  Patients often don’t understand the delays, and will many times complain to the insurance company, when, in reality, it’s the process itself that is causing the delay.

    I am here to help facilitate and track the requests, but patients should know the process ahead of time, and anticipate some delay in the medical records distribution.

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  • Tips from Paula: Understanding your lab work benefits

    Posted on June 7, 2017

    As the Employee Advocate here at Acadia Benefits, I get several calls each month from our customers who are unsure of how a claim for “routine lab work” was processed.  Because their doctor ordered this lab work as part of their routine physical, many people assume the lab work will be covered in full, similar to how the actual physical is covered.

    However, many insurance plans are set up to follow guidelines under the Affordable Care Act.  Those guidelines state that not all lab work is automatically covered in full.  There is a listing available at the following website: https://www.healthcare.gov/preventive-care-adults/.

    As we can see, the lab work on this list is limited. Therefore, if your doctor tells you they are ordering routine blood work as part of your annual physical, be prepared to possibly receive a bill for these services, as they will most likely be applied to the plan’s deductible.

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  • June 1st Breakfast Seminar

    Posted on May 10, 2017

    We hope you can join us for a breakfast seminar:

     

    Healthcare Cost Reduction Initiatives

    and ERISA Compliance Considerations:

    Tips for 2017 Open Enrollment

     

    Thursday, June 1st

    7:30 – 9:30AM

     

    Pierce Atwood, LLP

    254 Commercial Street

    Portland, ME 04101

     

    DESCRIPTION

    With the move away from fee for service to value based reimbursement initiatives, employers still struggle with healthcare costs and the shift towards high deductible health plans. Further, employers looking to bring added value to their employee benefits offerings may be doing so at the expense of ERISA compliance.

    Join our expert panel for a discussion on recent trends in health plan design and contracting to address healthcare costs and population health management, as well as tips and traps for employers offering voluntary benefits.

    Mike Burton from Acadia Benefits will be presenting along with John Larrabee from Harvard Pilgrim and Pierce Atwood Attorneys Christine Worthen and Byrne Decker.

     

    RSVP

    Please email Sara Pinto at spinto@acadiabenefits.com to RSVP to this event.

    We hope to see you in person, but if you can’t make it in and would like to attend remotely, please let us know.

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  • Tips from Paula: Who is Responsible for Obtaining Referral Extensions

    Posted on January 31, 2017

    Over the years, patients on HMO plans have learned the importance of obtaining referrals. What we need to remember, however, is that referrals are often written for a certain number of visits, or for a specific time frame. For example, a PCP may write a referral for a patient for three visits to an orthopedic specialist.    Once those three visits are up, it may be up to the patient to check in with the PCP for more referral visits, if necessary.   A good specialty practice may pick up that the number of authorized referral visits have been used up, but we should never assume this will happen. In addition, referrals are not “automatically extended”.  Therefore, it’s up to the patient to pay strict attention to their referrals, for time frame and/or number of visits allowed, and be proactive in following up for new referral visits if necessary.

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