Telemedicine has become a hot trend among insurance carriers and consumers. It’s not surprising since most services are now available online, so why not healthcare too? 

Telemedicine allows individuals to access a board certified and licensed physicians via phone, email or video chat - 24 hours a day and 7 days week - for common illnesses such as sore throats, UTI, allergies, common cold, eye infections, earaches and more. These doctors can diagnose and prescribe medication that the individual can pick up same-day.  

Have you ever experienced billing or invoice issues? Frustrated with people you already terminated still showing up on your bill? Look no further as your Fall River team is here to help! 

When processing eligibility changes such as enrollments, changes or terminations, you can follow these three simple steps to improve the accuracy of your carrier bills. 

Step 1 – Process On Time

• If you have an impending enrollment, change or termination, it is best to get these submitted to the carrier as soon as possible to prevent any processing delay. The cutoff for the next bill is often 2-3 weeks before the end of the month, which is why people you’ve already terminated can still be showing up if you didn’t terminate them soon enough.  If you want a person who’s terminating on 3/31, for example, to NOT be on your April bill, you may need to get that done as soon as 3/10, depending on your carrier and the billing cycle dates you’ve selected.
• If terminations are not submitted prior to the actual termination date, carriers do have the right to bill you for the following month of coverage. It’s the most common billing issue and unfortunately, there’s not much that can be done about it. In the Colorado fully insured market for groups with 2-99 employees, carriers will not allow terminations after the effective date unless proof of other coverage is provided.  So, that 3/31 term MUST be done on or before 3/31, otherwise you may be tracking down a copy of the employee’s next ID card before the term can be done.

Step 2 – Process Online

• Most carriers offer an Online Employer Portal for managing eligibility and paying premium invoices. The fastest way by far to process any eligibility enrollment, change or termination is to complete them online, as most carriers will update their systems in real-time or within 24 hours of the transaction. If you need help obtaining a login and password for an Employer Portal or would like additional training for your carrier-specific portal, please contact your Fall River Account Executive.
• Billing and invoicing cycles vary from carrier to carrier. The invoice should show your due dates, remittance details (including overnight payment or wire transfer options) and/or other carrier-specific instructions. 
• If you have signed up to receive electronic invoices, carriers will typically email you in advance when the invoice is ready to view. But watch out…sometimes these emails will appear in your junk folder and could go unnoticed unless you check that folder regularly. 

Step 3 – Audit Your Bill 

• As soon as you receive your premium invoice, whether paper or electronic, try to reconcile it with your records as soon as possible - the sooner the better while it is still fresh in your mind. If you notice any concerns, reach out to your Fall River Account Executive and we can help you get it resolved. Clients have called us after finally noticing errors that have been on the bill for many months – it is very difficult to help you get your money back if too much time has passed.
• Most carriers do not allow self-adjusting and require that you pay your invoice as billed.  There can be serious consequences to short-paying your bill, up to and including termination.  If there are folks on your invoice you’ve already terminated, the invoice will auto-adjust next month to credit the premiums back.
• If payments aren’t received within the 31 day grace period, carriers may terminate coverage and it can be difficult to reinstate. To prevent a lapse in coverage, make payments by the due date or call the carrier to discuss financial arrangements, and don’t self-adjust (ie short-pay) your bill. 

We hope these tips are helpful – please feel free to call us at any time at 303.369.3200 with any billing challenges you may be having.

After much success with our 2015 Self-Funding Feasibility Study, the Fall River team is back at it again!  

Fall River’s 2016 Feasibility Study will analyze the advisability for groups of different sizes and locations to become partially self-funded or whether groups already self-funded should be moving up or down the spectrum when it comes to risk continuum.  

Partially self funded plans are benefit plans that look and feel like a traditional health insurance plan. If they are structured properly, there is little or no risk to the employer with a significant potential to gain in a given year.  These plans can often deliver a better value and price than fully-insured plans because they are not subject to all of the rating requirements of the ACA.  There are also plans available that let employers “dip their toes” in the waters of self funding to get a feel for what their claims experience might look like. 

We do all the due diligence for you, utilizing our self funding expertise and our in-house actuarial tools to evaluate each scenario. We will present you with an analysis specific to your organization, at no cost to you. 

A short survey will determine if you are eligible. If so, we will contact you to schedule the review and provide a checklist of required documents.

For more information on the Feasibility Study, please attend our webinar on February 24th or contact Juliet Fitzgibbons by clicking here! 

2015 is almost over, so it is time to remind your employees to use up any remaining money they might have left in their Flexible Spending Accounts (FSA) or Dependent Care Accounts (DCAP) before the year is over!  

An FSA account may be set up as a “use it or lose it” tax-advantaged medical savings account, so if your employees don’t use it all up by the end of the calendar year, they stand to lose any remaining money you have left. It is possible that you may have implemented a grace period which allows your employees either an additional 2 ½ months to spend their FSA dollars, or that you have chosen to allow employees to rollover up to $500 into the next plan year.  Remember, changes to the use-it-or-lose-it rule must be written in to your FSA plan document.  A list of Items or services for which your employees can use their FSA dollars can be found in the IRS Publication 502.  

A Dependent Care Account (DCAP) is set up as a “use it or lose it” tax-advantaged account to be used to reimburse for eligible daycare expenses for children 12 and under or for adult daycare expenses for a disabled spouse or IRS tax dependent. There are no grace periods or rollovers for DCAP, so your employees have to use the funds in their account before December 31, 2015. For more information on what providers and expenses qualify, please see IRS Publication 503 here.

Please feel free to This email address is being protected from spambots. You need JavaScript enabled to view it. your Fall River Account Manager if you have any questions!