Greetings!

is basically a request for payment for services covered under the insurance plan. The STATUS OF A CLAIM is basically a request to find out how and when a claim will be processed & paid.

Claims are typically submitted to the health insurance company by the provider. Claims can also be submitted by the member. Each "line item" of a bill will be "adjudicated" or "compared/evaluated" against your insurance plan. It will then be processed for payment in accordance with you insurance plan contract.

Once the claim has been adjudicated, an Explanation Of Payment (E.O.P.) will be sent to the provider and an Explanation Of Benefits (E.O.B.) will be sent to the member. This will tell each party how the insurance company will be processing the claim, what balance, if any, will be the responsibility of the member and when the payment was processed to the provider.

You should get an E.O.B. for every date of service/line item you incur. Match these to your bills and keep them as part of your records. If you find you do not have a copy of a particular E.O.B., you may request a duplicate from the insurance carrier to be sent to you.

E.O.B.'s are typically produced within a couple of weeks from the date the insurance company receives them. In some cases, it could be longer, especially if there are outstanding pieces of information the insurance company needs.

If you have not received an E.O.B. and are concerned about how the claim was processed or that it may be on "hold" pending some additional information or records, you should feel free to contact your insurance carrier and simply state you would like to find out the "Status of Your Claim". This is a common service they are willing to provide their members. If you still need help, contact your Broker to help you get the information and answers you are looking for!

On January 28^th, two staff members from KIA Insurance, David Deitch and Robert Bishop attended a five day conference in Washington D.C. with the National Association of Heath Underwriters, NAHU.  This was the 19^th time this conference was held and was attended by 650 people from all over the country.  The purpose of this conference is three-fold.  First we discussed what health care issues and challenges there are that are affecting our clients, their employees as well as individuals. Concentrating on the most critical issues, we discussed legislation that is either pending or being proposed and discussed how this would affect our clients in either a positive or negative way.  Now knowing the issues and the proposed legislation, we went up to the "Hill" and met with our representatives to lobby them to vote in a way that would be beneficial to our clients.

We were fortunate enough to meet with all of our Congressional Delegates and their staff.  Congresswoman Berkley and Congressman Porter and Heller were gracious enough to spend some personal time with us which was nice.  On Thursday mornings, Senators Reid and Ensign host a Continental Breakfast on the Senate side of the Capital which we attended and were able to speak with Senator Reid, the new Senate Majority Leader.  That morning Senator Ensign was attending a prayer breakfast with the President and was unable to join us.

Some of the issues that we discussed with our Congress Delegates were:

• Keeping the State Children's Health Insurance Program from becoming a new federal entitlement program.
• Encouraging Health Information Technology such as "interoperable" electronic health records and Cost Transparency.
• Keeping the Medicare Prescription drug cost with the Private Sector rather then having the Government negotiate the prices. (The House of Representatives has already voted on letting the government do the purchasing of these prescriptions)
• We support an above the line deduction for Long Term Care and Health Insurance premiums along with making Long Term Care insurance premiums available through cafeteria plans.

While we were there we also received an update on the Massachusetts and California Insurance reforms, the Big Picture of Health Care Financing by Leslie Norwalk, Acting Administrator for the Centers for Medicare and Medical Services.  We also heard from Tommy Thompson, former Secretary of the U.S. Department of Health and Human Services as well as Orin Hatch (R-UT), Rep. Bobby Jindal (R-LA), Rep. Jason Altmire (D-PA), Ellen O. Tauscher (D-CA), Rep. Eric Cantor (R-VA), Rep. Pete Sessions (R-TX) which all gave us Congressional updates on HealthCare issues they see as being important to the New Congress as the balance of power has shifted.   Julie Goon, Special Assistant to the President for Economic Policy talked about the President's Health care agenda that he discussed in his State of the Union Address.

Other then the big issue of the war in Iraq, the second most important issue to the American people is the cost of Healthcare and the millions of people without health insurance.  You can't turn on the news and not hear a 2008 Presidential candidate talking about Healthcare.  You will undoubtedly hear references from the new Majority Party to "Universal HealthCare" or to a "Single Payer" plan such as they have in Canada which we strongly oppose.  We heard an excellent presentation on the Canadian Healthcare system and are convinced there is no better healthcare system in the world then what we have here in the US, though we agree that the system needs some help in a couple of areas.  Another Government sponsored plan is not the answer.

BROKERS' Clients are Consumers

By providing ongoing service and benefit expertise, the value of a broker is always evident. A good broker doesn't just sell insurance they know insurance.

Brokers have the ability to shop, sell and service many different insurance carriers' products. As part of your insurance premiums, insurance carriers pay brokers in the form of commissions. There is a true value to that service that both the insurance carrier and the employer recognize and enjoy.

Brokers often support small employers' Human Resource departments. Small employers often rely on brokers to assist them as a point of reference in the day-to-day handling of their health insurance needs. Many can also direct employers to qualified professionals to assist them with their other personnel matters.

Brokers also help individuals and the elderly, who often have a hard time understanding their insurance plans including Medicare. They take the time to answer questions in a manner that is easy to comprehend.

Brokers make complex benefit issues easier to understand. There are countless plan options. Good brokers take the time to understand their clients needs now and in the future.  They help clients implement plans that best suit those needs as they evolve. Educating employees on the benefits their employer provides is key as well.

Often government will implement State or Federal laws that affect employee benefits. Brokers track and understand these laws, explain them to their clients and offer direction to the governing entities by acting as a knowledgeable resource.

Brokers help resolve clients' problems. Because of their expertise and relationships with insurance carriers, brokers can often educate and assist their clients to get problems solved quickly and efficiently.

Partnering with a broker is a great step in ensuring you are utilizing the benefits you pay for to their fullest potential. Call us today to find out more about what service you should EXPECT from your broker, and how we can help you get started making the most of your decision to offer benefits!

Robert J. Bishop & Staff

KIA Insurance