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Hospital Advocacy . How it works…When to use it… What it will do….What it will not do. Overview of Advocacy Program. Member is “Active” status for at least 3 business days before hospital occurrence. Member has medical bills totaling $2500 or more for this hospital/medical occurrence.
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Hospital Advocacy How it works…When to use it… What it will do….What it will not do
Overview of Advocacy Program • Member is “Active” status for at least 3 business days before hospital occurrence. • Member has medical bills totaling $2500 or more for this hospital/medical occurrence. • Pre-hospital negotiations must be submitted at least 1 week prior to hospital admittance. • Member must remain “Active” throughout entire advocacy procedure.
Avoiding Member Issues • Member Eligibility • Prior Contractual Agreements with Hospital or Medical Credit Card. • Negotiating after Member has already paid Hospital Bills. • “Stale Medical Bills” • Member Communication • Bills in Collection • Member Payments • When is the ER eligible for Advocacy?
Webinar Q & A’s • Q – If a doctor’s office is located in a hospital, will the services be eligible for advocacy? • A – Location of a physician is not part of the equation. If any physician provides treatment to the patient while in the hospital and is not an AmeriPlan Health provider, the charges incurred will become part of the aggregate amount ($2500 and up) and will be advocated for a lower fee. If the physician is an AmeriPlan Health provider, the fees are already negotiated to a lower fee and will not be part of the advocacy service.
Webinar Q & A’s • Q – What does The Karis Group look at for income when determining someone’s ability to pay? • A – Adjusted Gross Income & Assets (property, stocks, bonds, etc.) • Q –Please clarify how a member can have hospital advocacy prior to a scheduled surgery. • A – The Karis Group needs a minimum of one week to work on a hospital case for a scheduled surgery. Therefore, it is very important that you contact medical customer service immediately when you know you are going to have surgery if you want the advocacy prior to surgery.
Webinar Q & A’s • Q - Does the 3-day active membership requirement apply to members who upgrade from Dental Plus to one of the medical programs? • A- Any new member to the medical programs must meet this requirement, regardless of whether they were an upgrade or not. • Q – If I have insurance with a high deductible, can The Karis Group advocate to lower my hospital fees. • A – No – there are legal reasons why this cannot be done.
