Tag Archives: claims

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

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Your Insurance Team's Support

Vantage Point: We Work Together to Support You

Painted in the stairwell of Samaritan Hospital is an inspirational message, “All of us, for each of you.” The same can be said of our Health Alliance Medicare team in North Central Washington that works together to provide elevated customer service for members and our provider partnerships.

Eileen, our program assistant, is the first face members see when they visit the Wenatchee office. Eileen feels that by supporting staff and prioritizing tasks, she can focus all her attention on members when they come in.

“Health Alliance isn’t just insurance coverage,” she says. “It is a place to come if you have questions, are seeking information, or would just like a cup of coffee and an ear.”

Jessica, our bilingual customer service representative, says, “The most rewarding part of my job is having the ability to see our members face to face, build relationships, and let them know I am here to listen and help.”

Through her role at Health Alliance, Teri, our customer service lead, hopes to insure our members only have good experiences when adverse situations arise. Teri credits the overall team from claims to medical management for its support in helping her achieve her goal.

Major procedures, hospitalization, surgeries, and discharge plans all need prior approval, and Cindy, our utilization review nurse on the medical management team, uses her experience in risk management, coupled with patient advocacy, to take care of our members through major health issues, thus controlling unnecessary costs.

Medicare is not only complicated for our members, it can be complicated for providers as well. Therefore, Leslie, our provider relations specialist, works directly with clinical staff members to help them understand policies, procedures, and operating systems. By providing face-to-face customer service at the provider offices, it makes providers’ jobs easier, positively impacting their care of our members.

The Centers for Medicare & Medicaid Services ranks Medicare Advantage plans on a five-star scale, and factors within that quality scale relate to providers assessing, managing, and controlling chronic conditions. Amanda, our coding consultant, works directly with physicians to provide coding education and finds it rewarding when she and the doctors learn something from each other, ensuring overall great health care to our members.

Whether they’re working with members or providers or making medical decisions behind the scenes, these are just a few of the local people committed to working together toward the common goal of ensuring quality of care, setting Health Alliance Medicare apart in North Central Washington.

Getting a Great Deal

Getting the Best Deal

“I’m always looking at ads to see who’s got the best deal,” Melissa Whitman says.

Who doesn’t love saving money? But how are great deals and health insurance connected? They may be more similar than you think, at least when you see doctors in the Health Alliance network.

“Many of our members are surprised how much they save by staying in-network,” says Melissa, a Health Alliance claims manager. “Going out-of-network can cost members twice as much, and the even more unfortunate part is they often don’t realize that until after their visit or procedure.”

With thousands of doctors and hospitals in-network (and the list growing daily), you don’t need an eye for a good deal. We have people like Melissa for that. Melissa can help with just about anything related to getting your covered care paid for.

Stepping into her cubical proves instantly there’s a lot more to Melissa than claims processing. Her family. Pictures of smiling faces decorate every open space.

“We’re always together. Cooking out,” she said. “In the summer they’re at my pool, and we just got done mushroom hunting.”

Melissa has quite the eye for those hard-to-find morels. For as long as she can remember, mushroom hunting has been an annual adventure.

“The whole family goes. Even my 89-year-old grandma gets her mushroom stick and gets in the woods,” says Melissa with a laugh.

She sums herself up simply. “I’m a city girl. I love my work, my family, and a taste of the country,” she says.