Services Provided
Basic Services
Details of Services
Claims Filing Service Check List
Fees/Sign Up
Basic Services
Total claims management
File, track and appeal (if necessary) unlimited number of claims
Maximize reimbursement
Review all medical bills for accuracy
Follow-up with doctors, hospitals and insurance companies
Tell you when to pay bills and how much to pay
Annual out-of-pocket medical expenses for taxes & periodic claims activity reports
Case management & consultation for benefit/policy alternatives
Member newsletter, The Claimgram, and consumer guides containing health reform
updates, money saving tips and inside information on maximizing your health
insurance benefits
Peace of mind and a good night's sleep, no more frustration, stress or wasted time
A more detailed description of these services is presented below.
Detail of Services
Total quality management of all health insurance claims - Unlimited number of claims.
Our basic program provides for the management of an unlimited number of claims, with dates of service beginning with the
effective date of the client's membership in the service, to be managed for the enrolled time frame. Any claims with dates of
service prior to the effective membership date are considered as back-up claims. These claims are treated separately from
the all inclusive unlimited claims activity. Such back-up claims will be managed, at the discretion of the client, and subject to
our back-up arrangement based on a percent of recovery as a result of CSA's direct intervention. These claims are handled
differently because past claims are more time consuming and difficult to manage.
Quality service originates with knowledgeable and caring medical claims assistance personnel. Over 75 years of combined
experience in health care, health care management and the health insurance industry provides the necessary foundation for
accurate and timely claims management. CSA becomes your representative and advocate, ensuring that with each medical
claim filed, all the client's financial and consumer related interests are protected. Each member is provided with a membership
kit with self addressed envelopes containing instructions on how to submit claims to CSA.
Maximum insurance reimbursement consistent with each client's private or government insurance benefits plan. Assurance
that clients have been charged only for medical services actually provided and pay only those bills required.
Each claim is filed accurately and promptly. Cutting through insurance company red tape and bureaucratic snafu provides for
faster turn-around time. Each claim is carefully examined to make sure all services were provided and reimbursed in
accordance with the policy benefits. Only when we are certain that the claim was paid properly, our clients are told when to
pay a bill and how much to pay, thus avoiding unnecessary and duplicate payments to providers. Proprietary software ensures
each claim is processed to a completed (no further action required) state ensuring no claims "fall through the cracks".
Each claim filed receives a timely follow-up to accelerate claims process and payment. Service includes the appeal of claim
decisions, if necessary.
Each claim is tracked through the member's doctor, hospital and insurance company to confirm prompt processing. Payments
received from insurers are tracked and secondary claims to other insurers, such as supplementary policies or spouse's
company insurance are filed. All reimbursements are sent either to the member or provider directly, and are never received or
transferred through CSA. Members are notified of what checks to write to their health care providers, thereby controlling
out-of-pocket expenses, and ensuring their continued control of their checkbook.
CSA does not hesitate to follow-up on claim rejections or what they consider to be inadequate reimbursement and validating
justifications for their denial. Appeals of claim decisions are submitted as necessary, at no additional charge, in order to
maximize the client's reimbursement and minimize out of pocket costs.
The March 1995, AARP Bulletin, clearly documented the complexities with the Medicare program and the lack of appeals on
the part of patients. The article stated that a recent GAO report "did find that the insurance companies that administer Medicare
turned down at least parts of 112 million claims in 1993!" It went on to further state that while "all Medicare beneficiaries have
a right to appeal denials, only 2 percent of all denials are appealed. However, more than 75% of those who do appeal are
successful." CSA's success rate is over 90%.
Each member is provided a periodic Claims Activity Report and an Annual Report of Out-of-Pocket Expenses that provides
valuable data for annual tax submissions.
Periodic and annual claims summary reports provide each member with the information necessary to assure peace of mind
that they are receiving all the benefits for which they are paying. An end-of-year out-of-pocket medical expense report aids in
the completion of tax submissions. Additional customized reports to accommodate clients can also be developed and provided.
All reports are generated from CSA's proprietary software.
Expert analysis concerning benefit and policy alternatives, including Medicare supplements and long-term care plans.
Members considering either upgrading or changing coverage can rely on unbiased assistance reviewing and analyzing
comparative coverage in health insurance policies and benefits. CSA does not sell or endorse insurance policies; thus offering,
the most objective evaluations which aid clients in making appropriate decisions regarding coverage and benefits.
The Claimgram, the official CSA newsletter, valuable Information guides and special programs.
Quick, easy to read "plain language" information in the form of a newsletter that contains special reports, health reform updates,
insider information, money saving tips and opinions on health care reform issues. Each member feels more confident about his
knowledge of the complex and controversial health care system.
CSA has also written a number of information guides that are available to its clients at no additional cost. They include
Getting Your Money's Worth From Health Insurance and How To Speak "Health Care" - A Consumer's Glossary of Health
Care & Insurance Terms. CSA will provide other timely information guides as the need arises.
CSA also offers both professional and consumer education programs related to understanding the Medicare Program,
helpful hints for filing health insurance claims, and Medicare Supplement and Long Term Care Programs. These educational
presentations serve to promote concern about unnecessary medical expenditures, increase consumer awareness of problems
and solutions in health care reimbursements and at the same time expose the public to the full range of CSA services.
A modified Case Management program provides for alternative course of medical and ancillary services.
Upon request, clients will be offered guidance in determining alternative medical and ancillary services that may be necessary.
This service is under the direction of CSA Senior Vice President and co-owner Carol Matoren BSN, RN, who has years of
experience in developing and managing discharge planning, utilization review and case management services.
Claims Filing Service Check List
Use the following guide when evaluating a medical bill management and claims filing service.
Does your claims filing service provide:
Yes No
1) Filing and follow-up management of unlimited numbers and types of claims including review and
appeals when indicated?
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2) Telling you when to pay bills and how much to pay?
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3) Periodic summary reports on claims activity and a year-end statement showing out-of-pocket medical
expenses for income tax purposes?
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4) Policy and benefit analyses whenever considering upgrading or changing health insurance policies to
make sure the client gets what he is paying for?
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5) A member's newsletter with health reform updates, money saving tips, and inside information on
maximizing client health insurance benefits?
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6) Timely health related consumer guides?
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7) Case management program?
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Fees/Sign Up
If you would like information about our fees, fill out the Feedback form (select Request Information in the categories drop down
and specify Fees information in the comments text box) and we will be happy to send you our sign-up package which includes
a fee schedule.
Copyright © 1998 Claims Security of America
