NJ Insurance Plans - Mike Sheeran, CFP

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Horizon Blue Cross Blue Shield: How to read your health insurance claims EOB.

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Horizon Blue Cross Blue ShieldAs I mentioned in a previous post about health insurance claims, one of the first steps is to review the EOB. Horizon Blue Cross Blue Shield has put together a nice one page sheet to help members understand how their claims were processed.

 

EOB and Insurance Claims Notes From Horizon Blue Cross Blue Shield

 

Part of making the most of your health care coverage is understanding how your plan pays your claims and what your role is in that process. Horizon Blue Cross Blue Shield of New Jersey provides you with an important resource called an Explanation of Benefits (EOB) to do this.

 

The EOB is a document you will receive after you see a physician or other health care professional, at the time your claim is processed. On the EOB you will find claims and patient payment information for you and your covered family members on a single statement. The sample EOB below provides an overview of the information and what it means to you.

Horizon Blue Cross Blue Shield – How to Read EOB – PDF

 

 

If you are current client and need assistance, contact Mike Sheeran  or your dedicated account consultant at Glenn Insurance. You may also contact Horizon Blue Cross Blue Shield directly below.

 

Contact Horizon Blue Cross Blue Shield

If you have questions about
how to read your EOB, call
Member Services at
1-800-355-BLUE (2583).

Flexible Spending Accounts-FSA : Frequently Asked Questions

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In an earlier post about getting the most bang for your buck with your health care expenses, I mentioned FSA’s as one of your first tools to save some tax dollars.

If you have already started the process of setting up an FSA or are just not sure about them  yet, here are some of frequently asked questions that may help clear anything up.

Flexible Spending Account Frequently Asked Questions

I am not a tax professional, or legal counsel, so please consult with your advisor before acting on any tax advice.

 

1)What is a flexible spending account(FSA)?

A flexible spending account is a voluntary plan that provides the opportunity to convert part of your salary into tax-free benefits. 

The spending account will allow you to set aside pre-tax dollars from your paychecks to cover eligible health care expenses for medical, dental, vision and more.

 

2)If I put part of my salary into a FSA, won’t I make less money?

Your spendable income may actually increase by using an FSA. Lets look at an example.

Without FSA:

Taxable income of $50,000

FSA Contribution: $0

Subtract Federal and Social Security Taxes: $13,697

Health expenses: $2,000

Spendable income: $34,303

 

With FSA

 

Taxable income of $50,000

FSA Contribution: $2,000

Taxable income is now: $48,000

Subtract Federal and Social Security Taxes: $12,983

Spendable income: $35,017

SAVINGS of $714

****This is just an example of typical tax savings. Actual results may differ depending on your exact situation.

 

 

3)Why should I bother with the FSA when I can just take a deduction on my medical expenses on my tax return?

Medical expenses have to exceed 7.5% of your Adjusted Gross Income to be deducted on your tax form. FSA’s do not have to exceed that level. If your AGI is $50,000, than your expenses have to exceed $3750.

***As mentioned above, speak to your accountant to see how this will impact your overall situation.

 

4)Does a flexible spending account replace my existing insurance plan?

No, the FSA is meant to supplement those plans and provide a way for you to pay for any uncovered expenses on a pre-tax basis.

Always submit your claims to your primary insurance carrier and any out of pocket costs you may be paid for by your FSA.

 

 

5) Does that mean the FSA will pay my doctors for me?

No, you will have your own checkbook or debit card and you will need to make payment to the provider.

 

 

6) Are expenses that I paid with my FSA deductible on my tax return?

No, you get a deduction for what you deposit into the account so you cannot deduct it again.

 

 

7)How long is the FSA in effect for?

FSA’s will run calendar year and you must enroll every year and decide how much you will contribute to the plan. Your contributions generally cannot be changed during the year except in the instances below.

In the event of divorce or death of a spouse, you have the option to change your contribution at that time also.

 

 

8)What if I don’t spend all the money in the account? Can I use it next year?

No, unfortunately any unused money does not rollover into the next year. For this reason, you must be careful not to put too much into the account so you don’t waste any money.

 

 

9)I have unused money in my account. Where did it go?

If you did not spend your money before the end of the plan year,  the money gets forfeited to your employer and is under strict regulation by the IRS.

 

 

10) What else am I missing?

In addition to the use it or lose it rule, keep in mind that since your contributions are going in pre-tax, your future social security benefits may be affected.

 

 

 

11)Exactly what expenses can I reimburse myself for?

The IRS has a nice guide on FSA’s and what is eligible. I recommend reading through the guide. Additionally, they have removed some expenses from the eligibility list like over the counter prescriptions.

Publication 502 Medical and Dental Expenses

Publication 969 Health Savings Acccounts and Other Tax-Favored Health Plans

Information on changes to the FSA in 2011

 

 The list below was taken from Publication 502 and will link directly the the IRS webiste.

Health Insurance Claim Denied? You Don't Have to be an Insurance Pro to Get Your Claim Paid Fast.

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Health Insurance is great when it works, but when your claims get denied, it can be extremely frustrating. The good news is that you can probably get the denial fixed pretty easily; the bad news is that denials are becoming more frequent for everyone.

I work on many claims weekly, and have dealt with nearly all of the New Jersey insurance carriers in getting them corrected. I’ll give you the basics on how to get “most” denials fixed and paid for.

Stage 1

In my experience, most claims are denied because of missing information, incorrect information, miscommunication, or some other billing error. That is good because you can generally get these corrected within a call or two to the insurance carrier and the billing provider. For these, call your insurance carrier and physician and get whatever needs to be corrected, corrected. Be sure to write every single thing down including  names of people you spoke to, reference numbers, dates called and all correspondence regarding the claim just in case.

Stage 2

At this point, some of you that thought you were done in Stage 1 are still fighting the same claim. Persistence counts so make the phone calls again and be sure to reference everything you have written down up to this point.

If you are in a situation where it wasn’t an easy fix, I recommend getting a copy of your insurance contract to review plan provisions and make sure things were processed correctly and according to the plan documents. If they were not, get ready for you first appeal. The contract will tell you how to go through this process.

Stage 3

Yep, some of you will still be working on the same simple issues. Keep persisting until it is fixed!!!

If you filed your first appeal and it was denied, proceed to the 2nd level appeal as directed in your contract.

Stage 4 and Stage 5

Repeat Stage 3 until you are done.

 

I know I haven’t revealed anything magical about how to get claims fixed, but the truth of it is that it comes down to persistence, documentation and follow-up. If you aren’t comfortable going through the process, you should employ the help of your insurance broker as early as Stage 1 so they can assist. If your broker can’t or won’t help, call me and I would love your business and the opportunity to help.

 

 

Correcting Your Health Insurance Denial to Get your Claim Paid Fast.

Before I get into the process, the most important thing is to document everything including times called, keep copies of every correspondence, reference numbers and everything else pertaining to the claim.

 

Health Savings Account Resources for New Jersey Businesses and Individuals

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Sometimes it can be difficult to get the specific answers you need regarding the tax laws and exactly how HSA’s tie into your health insurance. I have put together a set of resources where you can find an answer to pretty much any question you can think of regarding, tax code, eligibility, and everything else that goes along with having and administering an HSA. I have everything from government resources to the resources through each New Jersey Health Insurance carrier.

 

Health Savings Account Resources for New Jersey Businesses and Individuals

Government Resources

1)IRS Publication 969 – Health Savings Accounts and Other Tax Favored Plans

2)Publication 502 – Medical and Dental Expenses – Including the Health Coverage Tax Credit

3)HSA Indexed Amounts for 2011

Contribution Levels for HSAs:

  • For calendar year 2011, the annual limitation on deductions under § 223(b)(2)(A) for an individual with self-only coverage under a high deductible health plan is $3,050.
  • For calendar year 2011, the annual limitation on deductions under § 223(b)(2)(B) for an individual with family coverage under a high deductible health plan is $6,150.

High deductible health plan.

  • For calendar year 2011, a “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,200 for self-only coverage or $2,400 for family coverage, and
  • the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $5,950 for self-only coverage or $11,900 for family coverage.

4)HSA Indexed Amounts for 2012

Annual contribution limitation. For calendar year 2012, the annual limitation on
deductions under § 223(b)(2)(A) for an individual with self-only coverage under a high
deductible health plan is $3,100. For calendar year 2012, the annual limitation on
deductions under § 223(b)(2)(B) for an individual with family coverage under a high
deductible health plan is $6,250.
High deductible health plan. For calendar year 2012, a “high deductible health
plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,200 (no change from calendar year 2011) for self-only coverage or
$2,400 (no change from calendar year 2011) for family coverage, and the annual out-of pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do
not exceed $6,050 for self-only coverage or $12,100 for family coverage.

5)Preventive Care Services Covered Under the Affordable Care Act – Use this to see what services you can get with zero copayment or deuctible

 

New Jersey Health Insurance Carrier Resources

1)Aetna

http://www.aetna.com/members/individuals/health/plan_details/hsa.html

http://www.aetna.com/hsa/welcome_video01.html

2)Amerihealth

http://www.amerihealth.com/health_plans/de/over_50/hsa.html

List of services covered 100%- http://www.amerihealth.com/health_care_reform/for_providers/preventive_care.html

3)Horizon Blue Cross Blue Shield

http://www.horizonnjhealth.com/HRA_HSA_demo/index.html  HSA/HRA Demo

http://www.horizon-bcbsnj.com/myway/members/mychoices_hsa.aspx

List of services covered 100%

http://www.horizon-bcbsnj.com/SiteGen/Uploads/Public/horizon_bcbsnj/pdf/Health_Reform/Preventive_Care_Guide.pdf

4)Oxford Health Plans

https://www.oxhp.com/secure/materials/brokers/recent_comm/ohp_hsa_fact_sheet_7508.pdf

 

Miscellaneous Resources

1)ACS/BNY Mellon HSA – Horizon Blue Cross banking partner for HSA’s.

This website is one of the best I have found for the resources on HSA’s.

https://hsamember.com/  Main Site

https://hsamember.com/faq.html FAQ Section for Health Savings Accounts

https://hsamember.com/resources.html Additional Resources

https://hsamember.com/calculator2.shtml Tax Calculator to see how much you will save in taxes by using an HSA.

 

Summary

If there are any unanswered questions you still have or cannot find what you are looking for in these resources, please contact me and I will try my best to help you out.

Cheap Insurance in NJ

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Many clients and potential clients I speak to will ask for  a variation of the same thing.

“Where can I get life, health, disability insurance for the least amount of money?”

What is the cheapest plan I can buy?”

Before speaking to me, they have probably scoured the web getting quotes for cheap insurance in NJ and so they have an idea of what they should pay or want to pay for their coverage. The problem is: the coverage they were quoted is nearly worthless, or it will not provide the coverage needed. 

 

 

The better questions to ask are : What is the best value for the coverage I am looking for? This is what I am trying to protect, what will the best value be?

Purchasing the best valued insurance, vs the least expensive, can mean the difference of getting your claim paid or not…..

So before you fall into the trap of buying the cheapest insurance available, ask your agent to do a full review of what they think you should purchase and what the best value will be.

 

Cheap Insurance in NJ – Pitfalls

Life Insurance

  • Term policy won’t be convertible
  • Policy may only be convertible for the first 5 years instead of full 15, 20 or 30 years of coverage
  • Coverage may only be convertible to a few select policies instead of the companies full portfolio
  • Horrible guarantees on universal life or whole life policy
  • Insurance carrier has sub-par rating

Convertibility may not mean much now but what happens if your health changes drastically and you still need coverage later?

Disability Insurance

  • Insurance company can raise rates if they choose to
  • Definition of disability is written as “any occ” instead of “own occ”
  • Insurance carrier has a history of not paying claims appropriately

Having a quality disability policy, vs a cheap one may mean the difference of your claim being denied or collecting on a few thousand dollar per month benefit.

Health Insurance

  • Does the coverage have lifetime limits?
  • Is the network of physicians limited?
  • Does the plan follow the same state mandates as other coverage?
  • Does the company have a history of not paying claims appropriately or are there many complaints online?

Some health insurance options might put limits on key services or may exclude services you may need.  (EPO Plans)

 

If you think you have found a deal too good to be true, please contact me and I will help you fully evaluate your needs and the plans you are considering. If the plan you are considering, is much cheaper than other options, there may be a reason! Find out why and know before you buy!

Get your NJ Health Insurance Quote Today!