Problem:

The benefits manager of an AFIS Benefits client failed to properly submit employee enrollment applications for medical and dental coverage for a period of three months.This oversight left employees without medical and dental coverage, and opened the employer to possible legal problems.

Solution:

AFIS Benefits successfully enrolled the late applicants by calling key contacts within the insurance carrier, requesting the matter be expedited. In addition, one employee without coverage had a dentist appointment the following day. Once again, AFIS Benefits used ties with the carrier to ensure the employee was able to visit the dentist. AFIS Benefits coordinated a conference call between the AFIS Benefits office, the insurance carrier and the dentist's office. AFIS Benefits obtained coverage for the employee even before the application was fully processed. Through the development of relationships with key individuals in the insurance field, AFIS Benefits cut through the red tape often found in many large industries.

Success:

AFIS Benefits was able to get the uninsured employees enrolled, saving time and money for the employer and keeping the employer out of court.

Problem:

An employee's claim for an ambulance event was denied. The insurance carrier that denied the claim insisted that the event was not life-or-limb threatening and therefore not responsible for payment. The employee's husband, however, rode in the ambulance, and ultimately died of a heart attack upon arrival at the hospital. The claim denial resulted in the ambulance provider repeatedly sending the grieving employee bills and threatening collection notices. The grieving employee was harassed for nearly ten months until the employer contacted AFIS Benefits.

Solution:

AFIS Benefits' first concern was to relieve the employee of any contact and notices by both the insurance company and ambulance provider. The ambulance provider was contacted and informed that the claim was in the process of being resolved. Then a 45-day restraint of all bills and notices to the employee was requested. Once the ambulance provider agreed, the employee was no longer harassed. Next, the insurance carrier was contacted to find out why the claim was denied. AFIS Benefits discovered that the claim had actually been denied because of missing paperwork requested from the very ambulance provider that had been repeatedly harassing the employee. The ambulance provider was immediately contacted with the request that additional information be faxed directly to AFIS Benefits, ensuring total control over the process. Within one week, the documents were received and forwarded to the insurance carrier. The carrier then reviewed, processed and paid the claim to the ambulance provider within three weeks. The claim was processed and resolved within one month from the date AFIS Benefits was first contacted by the client. Though the entire process took one month, the employee had confirmation within one week that the situation would be solved.

Success:

Due to AFIS Benefits' advocacy, as well as the continual cultivation of relationships with key insurance carrier contacts, the claim was quickly resolved with no out-of-pocket expense to the employee.

More than just consultants, we are your advocates.

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