ClaimLinx Client Service Success Story

We originally received this member’s claim on 11/25/13. The primary carrier left the member’s balance at $7,000 which was much higher than her out of pocket maximum. This amount was questioned by the group, which prompted the Service team to contact primary to explain their process of the claim.

Related Post: Tips For Helping Members With Claims Issues

When we spoke with the primary carrier they could not explain why this claim was processed the way it was. They are going to review and reprocess all of her 2013 claims so there may be some additional refunds. So far we at least saved the group $7,000 on the one claim, but may have saved them even more once the primary carrier has reprocessed their claims.

Going above and beyond in our Client Services by researching claims and contacting primary, we were able to determine primary’s processing error and save the client and the member on their out of pocket expenses.

Related Post: What is the difference between primary and secondary coverage?

At ClaimLinx, this is just another example of how we save our clients and members money.

If you have questions about a claim or need additional information, please email  We would be happy to help.

Half of Employers Hiring More Employees Aged 50+ in 2014

According to a recent Career Builder Survey, 53% of employers plan to hire employees aged 50 and over in 2014 (up from 48% last year). Even though many of these workers are over-qualified, 77% of employers said they would hire them for entry level positions.

Related Post: Hiring in November and December Bolsters Job Picture

The survey brings “good news for workers looking for a new job at the end of their career,” says Michael Erwin, a spokesperson for CareerBuilder. “In ongoing discussions with employers, we constantly hear that mature workers are good hires because of the intellectual capital that they bring to the team.” Less money has to be spent training mature workers and “they can act as mentors to the younger teammates. It makes good business sense to have a diverse workforce as companies continue to come out of the recession,” Erwin adds.

Although the recession caused many workers to delay retirement plans or forego them completely, 50% of those over the age of 60 said they would be able to retire within 4 years.  Women are more likely than men to delay retirement (71% of women vs 49% of men; 18% of women over 60 say they will never be able to retire, while only 7% of men said the same).

Reasons given for delaying retirement include:

  • financially can’t afford to (79%)
  • need the health insurance and benefits (61%)
  • like their job (49%)
  • enjoy where they work (46%)
  • afraid retirement will be boring (27%)

Related Post: How Employer-Paid Benefits Affect Your Bottom Line

The good news is that as retirement funds and the economy rebound, fewer people are delaying retirement than at the height of the recession. More people are finding they are able to retire without needing a part-time job, and if they are seeking work, they are more likely to be hired according the survey findings.

Please read the article written by Melissa Winn in its entirety here.

The Right to Health Benefits

The healthcare debate in America has been arduous. These issues have come to the center of the debate between Republicans and Democrats. The two parties continue to disagree on the success of the Affordable Care Act, and the benefits it brings to enrollees.

Related Post: ClaimLinx Glossary: Common Health Insurance Terms

Many US companies currently have policies in place that support benefits for same-sex marriage and protections for all gay, bisexual and transgender employees. Some companies that have noticeably embraced acceptance are Nissan, General Electric, Proctor and Gamble, and Walmart.

Obamacare currently allows same-sex couples to apply jointly for tax credits to help them pay for coverage, but this is not the case in private healthcare.  In March, the Department of Health and Human Services announced that any insurance plan that offers benefits to opposite-sex spouses must offer the same coverage to same-sex spouses. Companies have until January 2015 to comply.

With more than 7 million Americans signed up for coverage, the administration considers the law a great success. On April 1, the deadline for uninsured individuals to choose an insurance provider, Obama declared “This law is doing what it’s supposed to do. It’s working.”

Related Post: Start a path to savings on insurance

The president is calling for Republicans to end their bid to repeal the law.  However, after Obama’s victory speech, Republicans didn’t feel the same. They questioned some plans being canceled, premium hikes, and actual payment from those enrolled.

ClaimLinx is proactively ready for the many changes of Health Care Reform.  For more information please visit the Health Care Reform

section on our website.  For a free brochure, please email

If you have additional questions, please feel free to contact us at 513-677-6262; (800) 858-1772 or – we would be happy to help.

Humana Sees 202,000 Insurance Exchange Enrollees

Humana executives are disappointed in the current enrollment number of 202,000 from the state and federal insurance exchanges, according to an article in Modern Healthcare. That’s less than half of what competitor WellPoint has recorded. This figure accounts for less than 7% of those registered in the Patient Protection and Affordable Care Act since January 2014.

Related Post: Federal and State Healthcare Exchanges Performing Poorly

Those 40 and younger are making up 35% of membership, which is a 2% increase. Humana is attributing the younger enrollee numbers to options for lower deductibles.

Executives expect the low enrollment numbers to greatly affect their bottom line, and staff cuts to possibly follow. Humana’s Chief Operating Officer, James Murray said, “When we don’t get the revenue that we anticipated and we’ve built the administrative infrastructure to support that, we have a scale issue.”

Related Post: Supreme Court To Hear Challenge to Obamacare – What You Need To Know

Humana watched and benefited as competitors, WellPoint and UnitedHealthcare, were hit hard by the decision to opt out of the Medicare market. Because of the decision, competitors were forced to lower benefits and decrease their provider networks. Due to the low enrollee numbers, Humana may soon have to follow suit and make these same changes.

You can read the entire article by Virgil Dickson here.

Why You Can’t Afford Not to Offer Health Benefits to Your Employees

Rising health care costs, and changes in the health care system due to the Affordable Care Act (ACA) have many wondering if employers will keep offering employer-based health benefits to employees. According to Larry Boress, President and CEO of the Midwest Business Group on Health, the answer is yes.

Boress believes benefits serve multiple purposes other than providing health care to employees. He argues that providing employees with health benefits allows companies to recruit talent and ensure workers have the ability, health-wise, to perform well on the job.

Related Post: Why Insurance Rates Are So High and How to Start Cutting Them

Health care benefits are the second-highest expense for companies after payroll. In order to offset costs, he suggests companies have some of the following options:

  • identify disease and health problems early on
  • focus on prevention and management of chronic conditions
  • have employees pay higher deductibles and co-pays for care
  • consider using private health insurance exchanges
  • provide direct health programs and services to employees

Even with the high costs associated with benefits, companies continue to consider providing benefits a necessary expense and an investment in their employees’ health. Moving forward, businesses will need to come up with cost-saving strategies related to their health-care benefits.

Related Post: How Employer-Paid Benefits Affect Your Bottom Line

“At the end of the day, dropping health care coverage is not an option, especially for employers who are focused on the health and productivity of their workforce,” argues Boress. “Regardless of a company’s size, in a global marketplace, a business can’t afford to lose its most important assets – its people.”

Please read the entire article by Larry Boress here.

ClaimLinx is dedicated to providing its clients with the best possible benefit solutions that are compliant with the Affordable Care Act.

Please contact us to learn more.