• Get to Know Your Carriers

    We want you to take a moment and answer a couple questions. (We promise these are easy.)
    1. How many carriers are you appointed with?
    2. How many of their websites have you been to?

    The reason we ask is there is a whole network of information on those carrier websites.
    • Detailed information about their products
    • Live chat
    • Direct phone numbers for Agents Only
    • Material ordering (that sometimes goes straight to your house)
    • Promo ordering
    • Insurance Resources
    • Contact forms
    • Specials/prizes/events

    With AEP right around the corner we think it would be a great time for you to familiarize yourself with the companies that you are appointed with. By doing so, you have all the knowledge you need to give potential clients.

    Need some help finding your carrier website? Type the carrier name in the search bar of your preferred internet search engine and the carrier you are looking for should pop up on the top of your search.

    With that being said, we have another great reference for you to use:

    That’s right. Agent Pit Stop. Did you know that on our webpage you can:
    Click on the CLIENTS tab to see all your clients, plus you can see all upcoming birthdays. Making it easy for you to give them a phone call, send a card, or let them know of plans that may be more suitable to their health needs.

    Under the CONTRACTS tab you can see which documents we have on file and when they are expiring, plus you can request contracting information for carriers you may not be appointed with.

    The RATES tab has a search engine for you to use to better prepare you for your appointments. It helps your clients know the most updated rates that are available.

    The BILLING tab will show any balances you have with Van Berg.

    The COMMISSION STATEMENTS tab will show you exactly that. What date you were paid, the company/companies, and a file to download of the statement for that date.

    The SECURE EMAIL tab is for those who would like to sign up or log in to their secure email page.

    Last, but not least, the BLOG tab. Keep up to date with information about carriers, helpful tips, changes in insurance, and other information that may be pertain to the business.

    As always, if you cannot find what you are looking for here and still need additional help, we have several people in the office to help point you in the right direction. Please do not hesitate to call us at (800) 723-5228.

  • Balance Billing – What It Is and Why Your Medicare Advantage Clients Should Never See It

    Balance billing, in which a provider bills a member for the difference between what their carrier will pay for a service and that provider’s “retail” rate, is a relatively common practice in the medical industry and is allowable in certain circumstances for people enrolled in some types of individual and family plans. For Medicare beneficiaries enrolled in Medicare Advantage plans, however, the practice is explicitly forbidden by CMS except in a very narrow set of circumstances.

    With any Medicare Advantage HMO or PPO, including Point of Service HMOs and Regional PPOs, members are protected from paying more than their agreed upon cost sharing for any covered services. These kinds of patient protections are a key part of the Medicare system, and are agreed to by all providers who choose to treat Medicare beneficiaries, including non-contracted providers who agree to accept assignment on a case by case basis. While in some cases balance billing to the plan may be allowed, that should be handled between the provider and the plan and not involve the member. Unfortunately, if claims are processed incorrectly due to confusion or misinformation at a provider’s office, members may still end up billed for services for which, by law, they should not be liable. In the case of any confusion, members should be guided by the Explanation of Benefits provided to them by their carrier above bills sent to them by providers. It is not unusual to see a provider bill a patient before the claim has been processed and paid by the carrier, resulting in an incorrect amount shown due.

    It’s important to note that the restrictions on balance billing apply only to members in Medicare Advantage plans, and only to services covered by their MA plan and by Original Medicare. Members in Medicare Advantage plans that do not cover out-of-network providers, members seeking services that are outside the scope of their coverage (even through a Medicare participating provider), members who see providers who have opted out of Medicare entirely and are not contracted with their plan, and members with Medicare Supplement plans would all be subject to different charges and afforded different protections.

    As their agent, you are the first point of contact for questions or problems for many clients, so if a Medicare Advantage client calls you asking about a bill they received, refer to the following.

    If they saw a plan contracted provider – There is no balance billing paid by either the plan or the member. Member is responsible only for their share of cost as determined by their plan.

    If they saw a non-plan contracted, Original Medicare participating provider – There is no balance billing paid by either the plan or the member. Member is responsible only for their share of cost as determined by their plan, which may be higher than their share of cost when seeing a plan contracted provider. This situation applies only to members in plans with out-of-network benefits and does not apply to members in HMOs that do not cover out-of-network providers outside of emergencies.

    If they saw a non-plan contracted, non-Original Medicare participating provider – The Medicare Advantage plan may owe the provider the difference between the Medicare limiting charge and the member’s cost-sharing, but the member is only liable for their standard copay amount or their standard coinsurance percentage calculated using the Medicare limiting charge, not any higher amount billed to the plan by the provider. As in the above example, this only applies to members in plans with out-of-network benefits. For example, if a Medicare Advantage PPO member sees an out-of-network, non-participating provider, and the member has a 20% co-insurance for seeing out-of-network providers, that member would be liable for no more than 20% of the Medicare limiting charge, which is 109.25% of the Medicare fee schedule rate. The provider may bill the plan for any additional amount, but that should not involve the member.

    While members are of course still liable for their cost-sharing, including out-of-network charges, it’s important for agents to be aware of the potential for mistakes and to be able to help answer questions or reassure clients who may have concerns about billing, despite it being the primary responsibility of the carrier. After all, this is a service business, and even just a few pieces of information and the right phone number to call can make a client feel well taken care of, and that should always be the goal.