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Frequently Asked Questions |
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| Claims |
| Why do I get a
Coordination of Benefits Inquiry? |
| Why do I have to
complete an Accident Inquiry? |
| Why do I have to
complete a Student Verification Form every semester? |
| Why do my claims
keep getting denied? |
| I have been
contacted by someone from Intracorp. What should I do? |
| Do I need to send
a check for my deductible and co-insurance? |
| How do I use mail
order for my prescription drugs? |
| Does American
Administrators accept electronic claims? |
| Why is my
prescription drug being denied? |
| Who is the best
person to contact if I have a question regarding my claim: my |
| employer, my
employer’s agent representative, or American
Administrators? |
| When I look at my
claim on the website, it shows that a check has been issued, but
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| my provider says
they haven’t received the check yet. Why? |
| While I am on
vacation my prescription will run out. Can I get an early refill?
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| I will be
traveling out of the country. Will I have coverage if there is an emergency?
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| Eligibility |
| I just had a baby.
How do I add my child to my insurance? |
| Can I add my
girlfriend/boyfriend to my insurance? |
| Can I change my
plan option in the middle of my plan year? |
| Can I drop my
dependent’s coverage at any time? |
| How do I notify
you of a name or address change? |
| I lost my ID card.
How can I get a new one? |
|
| General |
| What is a Third
Party Administrator (TPA)? |
| What are American
Administrators’ normal business hours? |
| Why can’t I
sign in to view My Account? |
| Does American
Administrators offer individual health plans? |
| What is a PPO?
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| Claims |
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Why do I get a Coordination of Benefits
Inquiry? - You receive a
Coordination of Benefits Inquiry to help us determine if you or your dependents
have other health insurance coverage and if so which coverage should pay first.
We request this information annually.
Example: John has a family plan administered by American
Administrators. Jane, John’s spouse, begins employment with a new employer
and is now eligible to maintain insurance coverage through her new employer.
Jane decides to enroll in her employer’s plan and stay covered under
John’s plan as well. American Administrators requests annual information
regarding insurance status several months later. Jane completes the
questionnaire and advises us that she now carries insurance through her
employer. Jane’s insurance plan is primary for Jane because she is covered
under her employer’s plan as an employee.
Why do I have to complete an Accident
Inquiry? - When American
Administrators receives your claim, the claim generally does not contain notes
explaining why you sought services from a physician even though you may have
shared those details with him or her. Instead, the treatment your physician
provides is converted to a five digit code and posted to the claim. Certain
codes usually indicate that treatment was the result of an accident of some
kind. In order to verify whether treatment was the result of an accident, we
send an Accident Inquiry. The Accident Inquiry tells us if there is a third
party who may be liable for the accident. Example: John suffers a back injury
while playing basketball with his two children. He seeks services from his
chiropractor. The chiropractor submits a claim to American Administrators for
those services. When American Administrators receives the claim, we send an
Accident Inquiry to John requesting specific details to ensure that John, who
works for a construction company, was not injured at work. John completes the
form and returns it to American Administrators. The form is reviewed, and we
discover John was injured while playing basketball and not while working. The
claim is then reconsidered.
Why do I have to complete a Student Verification Form every
semester? - For most plans,
when dependent children reach 19 years of age, they are no longer eligible for
coverage unless they are full-time students at an accredited school. Because
students may enroll full-time in one semester but fail to enroll full-time in
subsequent semesters, we require full-time status to be verified by the
school’s registrar every semester.
Why do my claims keep getting denied? - Federal law requires that most claims be considered
eligible for payment or denied within 30 days of receipt. Many times additional
information is needed in order to process the claim. Therefore, we have to deny
the claim and request the additional information. A remark code at the bottom
of your Explanation of Benefits (EOB) indicates what information is needed.
Once we receive the requested information, your claim will be reconsidered for
benefits and payment.
I have been contacted by someone from Intracorp. What should I
do? - Intracorp is a
utilization review and case management provider subcontracted by American
Administrators to provide nursing assistance and counseling to employees and
their families when they have been diagnosed with a severe illness. A nurse
works with you and your physicians to provide the best treatment program for
you and confirms coverage with American Administrators for that treatment
program. It is a free service to you.
Do I need to send American Administrators a check for my deductible
or co-insurance? - No. Your doctor
will bill you for your deductible and co-insurance.
How do I use mail order for my prescription
drugs? - When you initially
enroll in your insurance plan you will receive a packet with ID cards. Enclosed
in that packet is a mail order/maintenance drug form. Simply complete and mail
the form, with a new prescription, to your mail order/maintenance prescription
drug vendor. If you have lost your mail order/maintenance drug form, please
contact American Administrators.
Does American Administrators accept electronic claims? -
Yes. American Administrators currently
accepts electronic claims through Midlands Choice. We will be expanding out
networks in the future.
Why is my prescription drug card being declined at the pharmacy?
- There are several reasons why your
prescription drug card may be declined. The problem could be as simple as an
incorrect date of birth, or the problem could be that your prescription exceeds
the limitations set forth by your plan. On the back of your ID card, there is a
help line for your pharmacist to contact your Prescription Drug Benefit
Manager. Your Prescription Drug Benefit Manager will be able to tell your
pharmacist the problem and the solution.
Who is the best person to contact if I have a question regarding my
claim: my employer, my employer’s agent representative, or American
Administrators? - Unless you have
been specifically advised otherwise by your employer, you should contact
American Administrators directly. American Administrators has the most
knowledge about your benefits and probably has information about your specific
situation that is not available to your employer or your employer’s agent
representative. In addition, our customer service representatives know what
relevant questions to ask, and you don’t have to worry about a
third-person’s interpretation and understanding of the situation and
information we provide. Furthermore, due to privacy concerns, we can only
release minimal information to your employer and employer’s agent
representative when they contact us about your specific situation.
When I look at my claim on the website,
it shows that a check has been issued, but my provider says they haven’t
received the check yet. Why? - There will always be a delay between the date a check is issued and
the date the provider receives it. This is due to normal accounting processes
of self-funded group health plans. Generally, after a check is issued, the
employer receives information pertaining to the check(s) (e.g. date and dollar
amount) and then funds (makes money available to honor) the check. Depending on
accounting cycles and mailing time, there could be a few weeks between the date
a check is issued and the date the provider receives it. If it has been more
than 3 weeks, feel free to contact us for the check’s status.
While I am on vacation, my
prescription will run out. Can I get an early refill in this situation? -
Typically yes. Please contact
American Administrators to find out if we are able to make a special
accommodation for your specific situation.
I will be traveling out of the country. Will I have coverage if I
need to seek medical attention? - Typically yes. However, if you travel outside of the
U.S. for the sole purpose of obtaining medical services, drugs, or supplies,
those services, drugs, and supplies are not eligible expenses under your plan.
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Eligibility
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I just had a baby. How
do I add my child to my insurance? - You must complete an Enrollment/Change Form. You can get
this form from your Human Resources department or on our website under the
Forms tab. You must be complete and return the form to Human Resources within
31 days of the child’s date of birth. Human Resources will then forward
the Enrollment/Change Form to American Administrators.
Can I add my girlfriend/boyfriend to my insurance?
- No. Girlfriends/boyfriends
are not eligible dependents under your insurance plan. In some states, common
law spouses are eligible dependents; however, you will need to research if your
state recognizes common law marriages and its requirements.
Can I change my plan option in the middle of my
plan year? - No. Plan changes can only be made during your
annual open enrollment period or during a special enrollment period. Please
refer to your Summary Plan Description to find out if your plan provides an
open enrollment period and for a list of special enrollment qualifying events.
Can I drop my dependent’s
coverage at any time? - Generally, you cannot drop your
dependent’s coverage unless there is a qualifying event.
How do I notify you of a name or address
change? - All changes to your insurance must be made in writing,
please refer to the Contact Us tab for our mailing address and fax number.
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| General |
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What is a Third Party Administrator (TPA)? - The
term third party may be used in the insurance/benefits field to describe an
assortment of outsourcing arrangements provided by large or small firms that
provide comprehensive, ongoing benefits administration and management services
to client employer plans. American Administrators uses the term third party to
describe our relationship with your employer and plan. That is, we are an
outside entity responsible for handling the day-to-day administration of the
plan.
Why can’t I
sign in to view My Account? - For your ID number, you need to
make sure you are only inputting numbers, no other characters, just as it shows
in the example. For your date of birth, you need to make sure you are adding
the forward slash and your 4 digit birth year, just as it shows in the example.
If you continue to have problems, please contact American Administrators.
Does American Administrators
offer individual health plans? - We are more than happy to work
with you to find an individual health plan that meets your needs. Please
contact (800) 456-4584 ext. 149 for more information.
What is a PPO? - A preferred
provider organization (PPO) is a network of medical doctors, hospitals, and
other health care providers. Health care providers who contract with the PPO
must accept discounted fees for their services. Therefore, health plans
contract with PPOs to help reduce the cost of medical claims. |
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