Cobra Insurance: Case Study

Once we are able to resolve your case and you receive payment from the insurance carrier, our firm’s fee is due within thirty (30) days of you receiving payment. We will request that confirm receipt of payment from the insurance carrier, so that we may forward and follow up with an appropriate bill our firm’s services. Any event you do not receive payment from the insurance carrier within a timely basis, please notify our workers compensation department so that we can insure payment is received as early as

When senior executive at Best Employer Company (Heather) was vacationing in the USA, she expected to return injury free. As Human Resource Manager, it is my responsibility to familiarize myself with the company benefits and inform Heather of the details. I feel the information below is well researched and offer good support about why I selected each benefit.

This week I began my 6-week internship at Blue Cross Blue Shield of Nebraska (BCBSNE). The first day was a common orientation for all new employees, internally denoted to as the “onboarding process” where all employees are told they matter. This full-day session communicates the core mission, vision and goals of BCBSNE, organizational structure, operating objectives, and workplace culture. BCBSNE is a not-for-profit health insurance company that is focused on collaboration to find the best solution for their customers; in other words, they are customer-focused. Since the implementation of the Affordable Care Act (ACA), many changes to the health insurance market required a change in the organizational structure and culture of BCBSNE. Through partnerships with providers, the goals of BCBSNE are to be responsive, accountable, minimize errors, and decrease costs – all components of the ACA. BCBSNE has strategically aligned their goals to those of the government-mandated goals, and implemented them at all levels of the organization, making them competitive in the health insurance market. I found this very fascinating: I was very excited after day one!

SC received a telephone call on 10/16/2015 stared 9:34 and end at 9:41 am from Tricia Crooks at Liberty Resources Home Choices (LRHC) Community Outreach and Enrollment Leader. Stating that she spoke Pa and he wants to resume his service order with LRHC for PAS service. SC informed SC that this information will first need to verify with Pa. SC expressed concerns about LRHC being able to fulfill service since they had the case unstaffed for over two weeks (09/25/15-10/15/2015). Tricia apologized on behalf of LRHC, and stated that they have someone assigned and is ready to go all is needed is the resumed service order ASAP. SC again explained to Tricia that Pa has to confirm this besides Pa was very adamant about switching provider because the

After notifying supervisor Ms. Monica Alvarez on 11-13-15 about the claimant’s allegations and her Workers’ Compensation claim, Ms. Redding received authorization from Ms. Alvarez to have the claimant to be medically treated at the Sunrise Medical

Reconsideration (Fordney, 2017) ----After initial claim is double checked and issues a statement of denial or a denial code, you can request a reconsideration, that shows, copy of claim, copy of denial, photocopy of supporting documents, reports or procedures, with proof highlighted. Also needed is a statement explaining the reasons for reimbursement of procedures. Form CMS-20033 is needed for this step.

The patient is very independent in his home and is able to perform all ADLS within the home without any addtional assistance. MSW asked patient if he was interested in any addtional care giving support in the home, but patient declined addtional support at this time. Patinet stated he gets transportation from his neiabors to the store when needed. MSW offered the patient additional transportation services, but the patient declined needing any addtional transportation services at this time.Patient reported falling back in 2004 off the steps and was air lifted to the hospital. Patient reports having diffculty paying doctors and helicoter bills. Patinet's only income is through SS for $847. Patient reported that was the only time he was fallen in his life. Patinet has only been in the hospital two times during his lifetime. MSW offered life alert services, but the patient was not interested. Patient stated his only concern was being able to afford his doctor and helicotor transportion bills. MSW connected AHCCCS and spoke to represtative regarding getting patient signed up for the medicare savings program. Representative stated the patient has already applied for AHCCCS back in

My office has completed the necessary steps to address the anomalous claim. My office is awaiting a response from your office to proceed with her request for a new claim.

The carrier has denied coverage of continued occupational therapy from 07/29/2015 - forward as not medically necessary. There is a letter from the carrier to the member, dated 03/29/2016, which states in part:

I am writing in regards to my bill. I've recieved multiple letters from paramus health center indicating that i would be called to court. This will be my second letter explaining that i was transferred to this hospital because my school psychologist ( whon i met for the first time) believed it would be the best thing to do. I was against this proposal but i could not refuse.

Mr. Reid allowed me to speak with Dr. Rampersaud regarding the required form. Once I spoke with him then I left to allow him privacy. On 6/18/18 I confirmed with the Adjuster Mr. Czapiewski that he would like me to place this file on hold. I did alert Mr. Eid to this fact

Risk assessment, case cost>$25,000.00 The current VRC has worked this case since May 2016. The consumer has attended college for four years; in 2016, he obtained a BA degree. He receives a tuition waiver because he is deaf. TWC has provided assistance with textbook, room and board, and interpreter services. Based on the financial information reported on RHW, the consumer is above BLR by $1,069.84, his parents claim him as a dependent. In 2013, VRC obtained AM approval to waive a portion of the consumer's contribution into the cost of services, but consumer's financial information has not been reevaluated. Policy requires that the financial information be updated at least annually . Case note dated 7/26/2013, says that consumer's mother

Thank you for your letter of 06/28/17 in which you demand $50,000.00 for a Section 32 settlement of the matter subject to a Medicare set-aside.

I've yet to receive any documents from Cobra showing that I'm even covered. I was expecting to receive some sort of insurance card or something? I only needed the coverage until 10/6. Considering we're almost 2 months in, I might just go without coverage until I become eligible. Please let me know what expenses have been incurred and I will pass it along to my employer.

The Lawrence’s should look for a good health insurance plan that consists of basic coverage for hospital and doctor bills. For example, the plan should offer at least 120 days' hospital room and board in full, provide at least a $1 million lifetime limit for each family member, pay at least 80 percent for out-of-hospital expenses after a yearly deductible of $1,000 per person, or $2,000 per family has been met, it should require no excessive exclusions, and finally the plan should restrain your out-of-pocket expenses to no more than $4,000 to $6,000 per year, apart from dental, optical, and prescription