EXPLANATION OF BENEFITS
Your help is greatly appreciated in reviewing your “Explanation of Benefits” (EOB).
With everything you’re hearing on the news lately about health insurance and all of its shortcomings within the Affordable Care Act’s “marketplace” I want to take a minute to help you understand what it means to be a part of a self-insured, self-administered health plan that is governed by a Board of Trustees (both Union and Employer).
To be self-insured means simply that; your health benefits are funded through Employer Contributions which are carefully invested and maintained in full compliance with strict federal regulations. This allows the Fund’s Trustees to make plan decisions based on THIS FUND’s claims experience and not the general population. As a nonprofit entity the Fund’s unwavering purpose is to collect employer contributions; invest them in the most prudent manner possible and create a strong reserve allowing the Fund to pay out health claims in an ongoing, timely fashion. Our focus is on serving you and your loved ones by providing unrestricted access to your health benefits.
To be self-administered means that the Board of Trustees are in complete control as to how your benefits are to be maintained and delivered to you in the best, most efficient way possible. As the Administrator of the Insurance Trust Fund, it is my responsibility to make sure that the policies and procedures, as they are outlined in your Summary Plan Description, are carried out in the most efficient, accurate way possible.
You’ll be comforted to know that over the years the NOITU Insurance Trust Fund has developed very strict, cost-effective safeguards in all our systems that allows us to always be aware of aberrant claims and to provide better ways to help expedite claims processing.
Being self-insured self-administered allows us the opportunity to safeguard your Insurance Trust Fund and to make sure that money is being spent in a prudent, compliant manner at ALL TIMES. An example of this is accomplished through the Fund’s Pre-Certification Program including concurrent review which allows a team of professionals, retained by the Insurance Trust Fund, to monitor your hospital stay making sure all that is occurring during your treatment is within acceptable medical guidelines in terms of medical necessity and medical appropriateness. This is by no means an easy task but it ensures that the Fund’s assets which belongs to the participants of this great Union are being spent properly.
This brings me to the most powerful auditing tool the Fund has access to and that’s YOU. When you submit a claim to the Insurance Trust Fund and soon after payment is made, you receive the Explanation of Benefits (EOB) at home and tend to treat it, like most of us, like it’s just another piece of mail. Please don’t do that. It is imperative that you look this document over carefully and understand exactly what services your doctor indicates he or she has provided and how much is being charged and how much the Fund is paying. The fact that your claim submission perhaps didn’t result in money coming out of your pocket is no reason for you to not take a close look at your statement. Be sure that the dates of service on the form are accurate. Make sure the document in general makes sense to you. For example, if you went to the doctor’s office for a simple office visit or had a minor procedure performed then ask yourself, why are there so many charges listed on the EOB and why has so much money been paid. Only you know exactly what took place during your treatment. Even though the Fund reviews Doctors’ notes and formal clinical documents when warranted there is no better way to control unnecessary costs than by you taking that final step and review your EOB.
If you need clarification as to what it is you see on your EOB or are alarmed by what you see then please don’t hesitate to contact the NOITU Insurance Trust Fund’s Member Services Department at 718-291-3434.