WorldDoc Health & Wellness Resource for Healthcare Consumers

Everyday, we are faced with a myriad of health-related decisions:What to eat?Should I exercise? If I have a symptom, what ailment might I have?What is my best treatment option?Where is the best place to go for treatment?To help make informed decisions, healthcare consumers need resources to make informed and effective choices.That is why CenBen USA is offering its customers the strongest web based health management program available today, WorldDoc.

WorldDoc provides interactive, customized health decision support services and health-coaching services. Developed by board-certified doctors in 20 specialties, WorldDoc provides health education to empower members to make informed healthcare choices. WorldDoc is a one-stop solution for participants to learn about their health decisions and manage their healthcare dollars.

“WorldDoc helps consumers make better healthcare decisions,” said Mary Catherine Person, Vice President of Account Management and Product Development for CenBen USA.“As a result, employees and employers save costs through healthcare education, prevention and individually tailored wellness initiatives.”

Use WorldDoc tools to make informed health choices:

• Evaluate symptoms and assess health risks
• Research conditions and treatments in the extensive physician written library
• Maintain online health files
• Communicate with medical providers and post messages and questions to the secure health forum
• Compare prices and find generic alternatives to medications
• Compare hospitals based Average Charges, Average Number of Days, Mortality Rate, Complication Rate, Number of Patients and more.

Contact your CenBen USA representative to learn more about WorldDoc.

CenBen USA Adds Lab CardProgram to Healthcare Benefits

Do you know what one of your plan participants is charged for outpatient laboratory testing each time their doctor orders lab work for them?Did you know that anywhere from 5% - 13% of a company’s total healthcare dollars are spent on outpatient laboratory testing services?On a national level, estimates for outpatient laboratory testing are at $20 billion annually.Our extensive review of lab costs led us to contract with LabOne for use of their Lab Card program.

How the Program Works
Lab Card is a voluntary benefit offering 100% coverage for outpatient laboratory testing that can be added to your medical plan.If your plan participants do not use the Lab Card, normal benefits apply. At a physician’s office, plan participants simply show the Lab Card and/or Healthcare card with LabOne’s logo and let the physician’s office know that their lab work must be sent to LabOne in order to receive free laboratory testing.Most of the time, the physician collects the specimens and calls LabOne for pickup.LabOne performs the tests and sends the results to the doctor (usually within 24 hours).

If the physician is unable or unwilling to collect your specimens, plan participants can call LabOne at 1-800-646-7788 to see if there is an approved LabOne collection center in the area.If there is, plan participants can take a test order from their physician to the collection center.At the LabOne collection center, plan participants show their Lab Card to the office staff and to the person who collects the specimen.The specimens will be collected and sent to LabOne.

If for some reason plan participants are not able to have the specimens sent to LabOne, plan participants won’t be able to take advantage of this program.However, it won’t cost plan participants or the plan more than it has in the past… regular benefits will apply.For more information contact your CenBen USA representative or visit www.LabCard.com.

Plan and Participant Saving
For the most recent 12 months, our PPO discounts for outpatient laboratory charges have averaged 38%.LabOne’s discounts usually exceed 60%.One of the most common “packages” of lab services received is a Complete Blood Count (CBC), Lipid Panel, Thyroid Stimulating Hormone (TSH) and a Comprehensive Metabolic Panel.Based on our average PPO discount and actual LabOne charges, both the Plan Sponsor and the participant benefit from use of the Lab Card (see box).

Advanced Medical Pricing Solutions (AMPS)

One unfortunate by-product of the “discount” pressure exerted on healthcare facilities by managed care organizations is the “used car syndrome”, or the practice of marking up bills before they are submitted for payment and associated discounts.We have seen these “mark-ups” applied through services billed that have no relationship to the treatment of a patient’s condition, as well as significant overcharges for drugs administered during a hospital stay, surgical implants and supplies.

In order to address this problem and ensure we are protecting our client’s expenditures, CenBen USA has contracted with Advanced Medical Pricing Solutions (AMPS) to provide a clinical and billing review of all significant out-of-network and in-network facility bills that will be reimbursed at billed charges or a pure discount from billed charges.Specifically, all out-of-network facility bills exceeding $15,000 and all in-network facility bills with an allowed amount exceeding $25,000 based on a discount from billed charges are sent to AMPS for audit and/or negotiation prior to payment.

AMPS employs roughly 20 bill reviewers, as well as a panel of over 300 consulting physicians that are assigned claims for review based on their specialty.Areas of focus prior to negotiation with the facility include the appropriateness of services and/or drugs based on the diagnoses coded and the level of charges billed.In each case where AMPS identifies a discrepancy , it will negotiate directly with the facility and gain a written confirmation.The claim is then returned to the CenBen Operations Center with complete documentation to pay the claim.

We are very pleased to announce that CenBen USA has completed negotiations with AIM Healthcare to provide credit balance recovery services to our client base.This is another step in our efforts to provide the maximum level of claims cost control to our clients.AIM employs well over 1,000 auditors responsible for reviewing credit balance accounts at all hospitals nationally and returning amounts held in credit balance to our clients.

A credit balance is any amount a hospital has determined in excess of the amount they expected to receive for a billed service.The credit balances are caused by a number of different reasons, including:

• Reductions in billed charges made by a hospital that are not forwarded to us;
• Partial duplicate payments issued as a result of multiple adjusted bills sent to us;
• Payment by us and a third-party such as worker’s compensation;
• Or failure of a coveredparticipant to indicate that other insurance is primary, so we both pay as primary.
  

In almost all of the above cases, the overpayment of a claim will be undetected by us and the hospital will retain the money until it is requested.

Procedurally, AIM will identify credit balances due to our clients and request that we verify the existence of an overpayment.Upon our confirmation, they will take steps to recover the credit balance and return it to us, minus a fee that is a percentage of the amount recovered.We will subsequently adjust our records and forward the recovered amount to our client.