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When
you obtain services from a provider you will present your major carrier
card when you arrive. The provider will enter the information into
their records for current and future billing.
The provider
will not charge you a co-pay or co-insurance at the time of your
visit. Instead, by contract, they must submit the charges to your
major carrier for approval. Your major carrier will then discount
the charges according to their contract with your provider. Upon
your major carrier’s approval, you will receive an Explanation
of Benefit (EOB). This EOB will show the original amount charged,
the amount of the major carrier’s discount and the amount applied
towards the patient’s deductible.
Upon receipt
of the EOB from your major carrier, you will need to submit the
EOB to Administrative Solutions. You can either mail the EOB or
fax it with a completed Reimbursement Request Form. Once ASI receives
the EOB, a check will be prepared to the provider for the
employer’s share. This check will be sent to your employer for
signature and forwarded to the provider. At this time a copy of the check and
its details will be provided to the employee that will indicate
the amount of the claim that the employee owes to the provider.
The employee can either send in payment for their portion of the
bill or wait for their provider to send an updated account balance.
Either way, the employee is responsible for paying their share of
the charges.
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