Spending Your Health Dollars Wisely 

In an environment of double digit increases the spotlight is on health care costs and is challenging all employers. Finding solutions that balance employees' quality of care needs with a cost reduction program is now an achievable goal.

Healthy..........................................................................................................Don't Cut Benefits

Group Benefits Unlimited  looks beyond simple cost shifting or benefit reduction to control escalating costs. We deliver information to monitor, control and improve healthcare quality, manage inherent risk AND reduce cost!

Wealthy........................................................................................................Cut Benefit Costs

Our easy-to-use "Instant illustrator" quickly projects the financial impact of our programs to your bottom line.  We offer proven techniques to accurately assess program design changes and project future costs. Detailed reports allow for critical analysis of utilization trends, resource use and health risks.

Wise.............................................................................................................Get More for Less 

Auditing Program

Extensive auditing procedures and guidelines protect our clients from fraudulent and/or abnormally high service fee charges.

• Issuance of customized identification card with unique certificate numbers
• Mandatory requirements of original receipts
• Random Provider phone audits
• Healthcare Advisory Panel review of questionable claims
• Individual dollar maximum approval guidelines by claim processor
• Usual and customary claim guidelines.

Procedures differ by claim type.  For provincial hospital claims the following checks and edits are made prior to payment approval:

• Verification of claim – contact hospital to confirm patient required hospital bed
• Same day edit-confirm whether patient was released on the day of treatment
• Supervisor override code required for claims in excess of specified dollar limit
• >5 day stay- confirm whether weekend fees were charged for stays greater than 5 days
• Private room charge- check hospital bed policy. No charge is applied if hospital only has private rooms available. Confirm private room was requested vs semi-private
• Pre-payment audit required before approval
• Client questionnaire- verifies if room upgrade was requested by patient
• Physician letter – verifies if the upgrade was medically necessary

To submit a claim, covered members and/or dependents are required to pay the expense out-of -pocket and submit the original claim receipt along with identifier information for processing. If the Provider (Hospital) accepts assignment (agrees to invoice adjudicator directly), payment will be issued directly to the Provider on behalf of covered members.

Currently, EHC claims are submitted in a paper reimbursement environment and processed within five ( 5 ) business days of receipt.

Risk management solutions, utilization management and cost control are at your finger tips. Call our information center or contact us directly.