Thanks for providing this history, Trisha! Can you comment on the concerns expressed by many in this thread re: Kyle’s lack of responsiveness. Perhaps this is a good time for the organization to forge an alliance with a new insurance agent?

Thank you for this post. I am in the exact same position. I have been with that same company for 3 years. Kyle’s associate reached out to me in October asking if I planned to renew my policy and I replied “yes”. 3 emails and a voice mail later and I have not received a reply. My policy is about to expire.

Nicole Rochester

…In addition I would carefully review the claim submitted as the billed amount ($11,285.00) plus the plan discount ($1254.00) is equal to the allowed amount ($12,539.00)
If you do the math and subtract the payment of $8250 from $12,539.00, the remaining patient balance ($4289.00) is correct with a $1.00 discrepancy. I’d review the actual claim sub…[Read more]

Essentially Linda is correct. Any overpayment belongs to the insurer, unless the patient paid any co insurance prior to billing to insurance.
Sometimes a provider will ask for a deposit/coinsurance payment prior to a procedure, especially if the deductible has not been met.
In that case, your client may be reimbursed by the provider up to the…[Read more]

The person I worked with at hiscox – mentioned above – found health advocacy in a social work category. We talked through this and other options and landed there.

Medicare by age, Anthem through his wife’s employer.

Thank you Cindi & Nicole for your kind offers to help. Nicole, I don’t know if I’ll have time tomorrow, but I’ve got your email address handy.

Hi Cheryl,
I agree with Cindi, this could be more complex than meets the eye. If you need to chat before the holiday, I’m around tomorrow!

Does this happen to be a Cigna policy, by chance?

I’ve seen it happen with Cigna before, and Doug Alden posted a Cigna plan sponsor agreement on Linked in last year that reads: “Plan Sponsor acknowledges and agrees that, in some instances, payment to Participating Providers in accordance with Participating Provider Agreements may result in p…[Read more]

Cheryl,

How is your client eligible for Medicare (age or disability)? This is a really complex question because it also depends on how he has his Anthem coverage (employment or Marketplace). The interaction of these variables might mean that the decision of which coverage is primary isn’t his to make. I’m not sure though that without…[Read more]

Hi Linda,

I had responded with this in the general forum yesterday:

I would contact the payor to ensure the overpayment is correct, and that the claim was processed correctly. The money paid in excess of the billed amount does not belong to the provider/facility, and must be reported in the event that it should be returned.

I’ve seen this h…[Read more]

Hi Linda,

I would contact the payor to ensure the overpayment is correct, and that the claim was processed correctly. The money paid in excess of the billed amount does not belong to the provider/facility, and must be reported in the event that it should be returned.

I’ve seen this happen before and, ultimately, it can end in a mess because of…[Read more]

Another consideration when purchasing E & O insurance is coverage for prior acts. A person can sue you at any time which means if you change insurers (or they leave the industry) you want to make certain that your new coverage will cover your prior years of clients. I mention this given the back and forth about Markel. It would appear that if…[Read more]

I did have a policy through Kyle with Markel which expired. He advised Hiscox (after I reached out to him).

The online form wasn’t going through so I called and spoke to a person at the call center who was very helpful. There isn’t a category for us as many of you might know. She said the best category is “Life/Career/Executive Coaching” and…[Read more]

Thanks for the feedback Ginger!
I, for one, will be watching for the focus group opportunity!

Collaboration is Key!

Happy Thanksgiving to everyone!