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Advantage First Insurance Success Stories

Out-of-network negotiations

  • A client had an employee who did not consider the ramifications of using non-network providers. So, he arbitrarily chose hospitals and doctors outside the HMO network for an elective orthotic surgery. This left very little for the parties involved to work with in attempting to resolve this billing issue. Fortunately, our office was successful in negotiating with the providers and the carrier, and reducing the employee’s obligation from $46,000 to under $4,000.

Restoring lapsed coverage
  • A current client of ours, an attorney, had approached us with a problem regarding his Long-term Disability coverage. It had expired, without his knowledge. His broker at that time had neglected to notify him of the outstanding premium due. As a result, he lost critical coverage — coverage that is often difficult to obtain. We were successful in not only replacing it with a very high level of coverage (about a $25,000 a month, maximum benefit), but doing so at a much better price point.

Taking care of unresolved claims
  • An aerospace firm in Southern California approached us regarding a problem they were having with unresolved claims associated with their self-insured Workers’ Compensation program. These claims were affecting their bottom line, yet most of them never seemed to come to a close. We replaced their self-insured plan with a fully-insured plan, and had all claims closed within a six-month period, saving them hundreds of thousands of dollars.

Significant cost savings
  • A self-insured company was overpaying their claims by over a million dollars. We redesigned their employee benefits package, changed the claims processing and provider networks, and produced a savings of over one million dollars during the first year.
  • One of our clients, a multi-location maritime company, had an employee (one of the owners) who had an ambulance bill of $2,376. Once the insured called our HR Extensions team and let them handle the issue for him, he ended up owing nothing. In fact, he was reimbursed by the carrier for the amount he had paid out of pocket.
  • A national law firm headquartered in Irvine, California, and a client of Advantage First, had an employee who lived in New York. The employee contacted Deena, a member of our HR Extensions team, regarding a surgery for which she had been billed — one that made it appear as if services were rendered by an out-of-network provider. Deena looked into the specifics of the case — the dates of service and all associated claims, which totaled $49,609.54. In the end, the claims were reprocessed — correctly this time — and the employee ended up paying $1,500, which was the in-network amount that should have originally been charged.
Responding to employee issues and concerns
  • Sometimes employees call their employer with issues and concerns that the employer is too busy to resolve or look into. Sometimes these issues are very personal in nature. That is why our HR Extensions team is here — to assist our clients in dealing with these issues. We don’t always have the answer the employees want, but we are always willing to take the time to respond to their needs and concerns. HR Extensions represents a team your employees can go to for confirmation that their claims are being processed correctly. Our team can explain both benefits and costs to the employee. And, many times we can resolve issues that might otherwise overwhelm an employee and negatively impact their work day.



 


Phone: 949-215-5226 | License # OF30770