How to file a medical claim

Note: The below information is also listed in our member packets. Download your member packet now for more information like it about your plan. 

The first step for filing a medical claim for a ClaimLinx SOS Solution Plan is to show two ID cards when you visit your medical provider:

  1. Major medical insurance company ID card as primary coverage
    • Example: Anthem, Humana, Harvard Pilgrim, Cigna, National General, etc.
  2. ClaimLinx employer funded ID card as secondary coverage

Most providers will file claims with secondary coverage. However, if the provider does not file secondary or if you receive information at your home, send any of the following items by mail or email to help@claimlinx.com to assist us in processing your claim.

  1. Major medical carrier Explanation of benefits (EOB)
    • This document is usually received about a month after a visit with a provider and has the discounted bill amount. It will come from your primary insurance coverage company (Anthem, Humana, Harvard Pilgrim, Nation General, etc.).
  2. Documentation with diagnostic coding
    • Sent by the provider, diagnostic coding explains the services performed or any diagnostic informaiton. You can also ask for this when you leave your provider’s facility.
  3. Information about the provider
    • Especially important information is the phone number to reach the physical address and billing office. You may write this on any information you send or fill out a Provider Information Form.
  4. Invoices (not statements)
    • Invoices have detailed billing information, your account number, claimant name and diagnostics. Statements do not provide any additional information for processing.

Claims are processed within 10-15 business days. You can see the full process a claim goes through once it is received at ClaimLinx. You may download an explanation of benefits for your claim once it has been processed on the member portal.

Please note that if ClaimLinx is missing any information or is waiting on requested documents, a claim will take longer to process.

If you paid up front for any services you can request a reimbursement for the services. First, you must fill out the medical expense reimbursement claim form. Then send this form with a receipt indicating you paid for the services. This can include a credit card statement, receipt from a doctor’s office, pharmacy receipt, processed beck front and back or any other proof of payment. No services can be reimbursed without this information.

Savings creates opportunity to reinvest in employees with Aflac

ClaimLinx and Aflac – they go together like salt and pepper. Good on their own but even better together.

As experienced consultants, ClaimLinx shows businesses how to save money on their health insurance. Using a unique, time-tested strategy for purchasing benefits that combines traditional insurance through a major carrier with a self-funded plan, businesses can save 20 percent on their health insurance plan.

But what should owners do with all that savings?

We suggest taking that cash and reinvesting it in employees. The lower fees for the health plan easily free up funds to start a Benefits Bank with enhanced coverage through Aflac.

Owners can choose plans for employees or set up a specific dollar amount and let employees choose which coverage they would like for themselves and their families.

Aflac has so many insurance plans available there’s something for everyone. Employees can choose from options like accident, life, critical illness, short-term disability, dental, vision and more. And the best part is employees also get the exclusive perks Aflac provides, such as a wellness benefit, one-day pay and a wide range of coverage options.

Supplemental insurance is often an important component to having a complete plan should tragedy strike for an employee. It can be a vital source of funds if gaps in coverage on a regular health plan occur. After all, the last thing anyone wants to worry about during an emergency is how to pay for care.

It sounds like a luxury for most employers – providing that level of coverage. But it doesn’t have to be.

Because ClaimLinx helps lower the cost of the overall health plan. Then the additional coverage through Aflac is purchased with pre-tax dollars. That means at no extra cost than your current health plan, you are able to not only keep current employees happy by improving benefits but also increasing your competitiveness in the job market.

So with all these additional benefits, can you really afford not to make the switch?

Physicians Lack Tactics For Discussing Medical Costs

It’s never easy to talk about financial challenges. But when the topic is avoided when doctors are talking about medical costs, the consequences can be life threatening.

In an effort to quell this issue in the future, a study published recently in Healthy Affairs explores the dynamics between physician and patients when talking about finances. The study examines the question “are physicians prepared to help patients factor out-of-pocket expenses into medical decisions?”

It’s a topic that becomes increasingly important as patients are saddled with shouldering more of their own healthcare costs. In theory, the increased financial responsibility is supposed to make patients sharper consumers and empower them to trim unnecessary spending.

However, previous study has shown increased costs often lead to people skimping on both valuable preventative care as well as superfluous diagnostic and treatment services.

This study recognizes that doctors could play a key role in helping patients find appropriate, affordable care by talking more about the out-of-pocket costs. But a lot of work would need to be done to achieve this change, according to the study.

“We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” Peter Ubel, the study’s main author and a physician and behavioral scientist at Duke University, said.

For the study, researchers analyzed transcripts of nearly 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested the care might be too expensive and assessed how doctors responded.

Researchers found that overall physicians dismissed patient’s financial concerns, either by not acknowledging them at all or by only half-addressing them.

For example, if a patient pointed out how expensive a drug is, the doctor might ignore the comment completely or might only suggest a temporary solution – like a free trial – without exploring long-term strategies to address the problem.

And, without a long-term plan, patients may eventually stop taking the medication, or take it irregularly. That can harm their health, resulting in a potential costly hospital visit.

Changing doctors’ behaviors likely won’t be easy, as this is a relatively new aspect to an age-old position. Physicians have not traditionally been taught to listen for patients’ pocketbook concerns, and when they do register, doctors are not accustomed to talking about cost barriers. Many might even think it’s inappropriate to bring up money at all.

Another hurdle for this conversation is that physicians are not always aware of a procedure or medication’s cost. They may be just as surprised as the patient by the high price tag of some drugs and services.

“It’s not as though, ‘Oh, it’s just consumers can’t figure it out.’ Doctors don’t know,” Jonathon Kolstad, an assistant professor of economic analysis and policy at the University of California Berkeley, said. When it comes to figuring out what a drug will cost, “doctors are in the same boat.”

FDA Joins Modern Nutrition Thinking With Updates

Which afternoon snack do you think is healthier: a handful of almonds or a handful of Frosted Flakes?

According to the Food and Drug Administration’s current definition of the word “healthy,” you should grab the Frosted Flakes.

The agency announced this month that it will be reevaluating its regulations on which foods can be labeled “healthy,” as well as other nutrient claims, after decades of evolution in the field.

 “Just because a food contains certain ingredients that are considered good for you, such as nuts or fruit, it does not mean that food can bear a ‘healthy’ nutrient claim,” FDA spokeswoman Lauren Kotwicki wrote in an email to the Los Angeles Times.

Current food regulations reflect the more simplistic views from the 1980s and 1990s. As such, food can only be marketed as healthy if it meets five criteria: fat, saturated fat, sodium, cholesterol and beneficial nutrients, such as Vitamin C or Calcium.

When the term “healthy” was first officially defined in 1994, low fat content was the primary focus for health professionals. Sugar content, processed chemicals and sodium levels were not yet on the FDA’s or most nutritionists’ radar.

For this reason, foods like Kellogg Co.’s Frosted Flakes and Pop-Tarts and Campbell’s SpaghettiOs can be marketed as healthy. Though they are all still high in sugar and processed chemicals, they meet all the current criteria, as they are low in fat and are fortified with vitamins.

Meanwhile, foods like salmon, avocado and almonds could not be marketed as healthy under the current regulations, because of their high content of fat per serving.

Kind, makers of the fruit and nut bars, discovered firsthand how outdated the FDA’s regulations are when they received a warning letter to stop using the word healthy on its packaging. As most of Kind’s bars are made with almonds and other nuts, they do not meet the requirement for low fat content.

Kind has since petitioned the FDA to change the requirements and has received support from doctors, dietitians and lawmakers around the country.

“We very much hope the FDA will change the definition of healthy, so that you don’t end up in a silly situation where a toaster pastry or sugary cereal can be considered healthy and a piece of salmon or a bunch of almonds cannot,” Kind Chief Executive Daniel Lubetzky said in an interview.

Congress is pushing the FDA to make this issue a priority, as it affects how agricultural companies can market their products in the future. However, the process will still likely take several years.

If the FDA changes the definition, it will first propose updating the “healthy” definition, followed by a comment period for food makers and the public to submit their ideas and research what “healthy” means. Then the FDA will present its proposed rule change, followed by another comment period, the final rule and an implementation period to give food makers time to comply.

It would serve as a test case in a long list of necessary FDA regulation updates surrounding nutrition — changes many nutritionists agree are finally time to make.

Future For SCOTUS Still In Turmoil After Nomination

President Barack Obama halted speculation this week when he nominated Merrick Garland, chief justice of the U.S. court of appeals for the District of Columbia, to fill the vacant seat on the Supreme Court left by Antonin Scalia.

The drama surrounding the decision to fill the office rages on though, as members of the Senate must now decide if they will confirm the nomination or leave the seat vacant until the next president is elected.

At stake during this time of turmoil are a number of cases waiting to be heard and those already awaiting decision, including three cases concerning the future of healthcare. With only eight members of the high court left, there is an opportunity for a 4-4 split of the justices’ votes.

In the event of a split, the decision of the lower court is upheld, and the case is not deemed to have set any sort of precedent. The power of the Supreme Court as a final word and decision is effectively diluted.

Senate Majority Leader Mitch McConnell has already pledged that he will not confirm, or meet with, any nomination from Obama in an effort to involve the American people in the decision.

“The American people may well elect a president who decides to nominate Judge Garland for consideration,” he said on the Senate floor. “The next president may also nominate somebody very different. Either way, our view is this: Give the people a voice filling the vacancy.”

Garland, who was confirmed in his current position by a majority of both Democrats and Republicans, is seen as a moderate politically.

He has already been involved in a number of healthcare related cases, sometimes siding with hospitals and sometimes siding with the Department of Health and Human Services.

“The nominee that was selected is probable the exact type of nominee most moderate Americans would want – somebody that is in the middle of the political spectrum and is extremely qualified,” Stewart Verdery, the founder of the Monument Policy Group, said to the Wall Street Journal.

Democrats in Congress demand members of the GOP fulfill their duty and consider the nomination, but it is unlikely a decision be made until the results of the presidential election.

In the meantime, the remaining Supreme Court justices will hear arguments next week in the case of Little Sisters of the Poor Home for the Aged v. Burwell, regarding non-profit companies’ obligation to provide birth control at no cost to employees. A decision is expected in June.