LEVEL ONE – INSURANCE VERIFICATION
- Communication with Agency, Intended Parent, and/or Surrogate to retrieve all items needed to complete the Insurance Verification.
- Review of full Evidence of Coverage: understand policy verbiage to make phone call to insurance company.
- Phone call to the insurance company – reference number for the call is provided.
- Written professional opinion of policy coverage provided to all appropriate parties within (5) business days of receipt of all requested information to complete Insurance Verification.
- Consult with Intended Parent(s) to explain the written opinion and the next steps that need to be taken (if any) to ensure proper coverage.
- Insurance Verifications comply with California Family Code Section 7962.
LEVEL TWO – ACA POLICY MARKET SEARCH*
*Available only to current clients who have placed an ACA plan through ART Risk and is currently active (paid and current through December 31).
- Initial Consultation – our broker gets to know your situation.
- Plan Research – finding the best options for your Surrogate.
- Written proposal of possible insurance options.
- Second Consultation – discussion of plan options and financial/ coverage implications.
- One-on-one help for the Surrogate through the application process.
- Confirmation of coverage is emailed to all appropriate parties.
- Confirmation of first and second month’s premium being applied to account through preferred payment method.
LEVEL THREE – ACA POLICY PLACEMENT
- Available to all interested ART Risk clients whose ACA policy is not currently active as of December 31.
- Available to all interested clients who have not placed an ACA policy previously with ART Risk.
- Initial Consultation – our broker gets to know your situation.
- Plan Research – finding the best options for your Surrogate.
- Written proposal of possible insurance options.
- Second Consultation – discussion of plan options and financial/coverage implications.
- One-on-one help for the Surrogate throughout the application process.
- Confirmation of coverage is emailed to all appropriate parties.
- Personalized consultation and assistance throughout the application process.
- Confirmation of first and second month’s premium being applied to account through preferred payment method.
LEVEL FOUR – ACA POLICY PLACEMENT and MONTHLY MANAGEMENT
All Level Three items are included for those that enroll in the Level Four service level. The following is also included:
- One (1) Insurance Verification for one policy – if additional policies need review, the scheduled rate will apply.
- Third consultation – discussion with any party who wishes to discuss chosen plan (not limited to one party)
- Monthly policy check – ensuring policy remains in force and assist in resolving potential issues with payment.
- Personalized assistance throughout the entire journey.
- If a grievance or appeal is necessary to file with the insurance carrier, our Escalations Team will complete this process and provide outcome results to appropriate parties.
- Service is complete when agency contract ends with Surrogate.
LEVEL FIVE – MEDICAL CLAIMS MANAGEMENT
All Level Four items are included for those that enroll in the Level Five service level. The following is also included:
- Determination of Coordination of Benefits if Surrogate has two insurance policies.
- Review Explanation of Benefits from the insurance company.
- Contact insurance company concerning claims issues and then work to resolve issues (request reprocessing, submit grievances and appeals as needed).
- Communication with providers concerning billing issues and work to resolve issues – if insurance is not applied correctly: request bill be sent to insurance company for reprocessing, correct coding issues, etc.
- Communication with Surrogate and Agency to ensure ART Risk has received all bills. Once bills are received, ART Risk reviews all bills and submits to Agency or Intended Parents for payment to provider in a timely manner.
- A hands-on approach for all bills and claims to ensure they are paid correctly and according to the plan benefits – this makes certain you are not paying more than you should and the Surrogate can rest assured there are no unpaid bills in her name.
- A comprehensive, final report is provided when all claims and bills have been processed and a zero balance has been confirmed with all known and available providers.
