ASG Perspectives

ASG Welcomes New Team Member

Tuesday, January 19, 2016

We’ve added a medical specialist!

Sara Winand, RN, has been named Director of Medical Management, responsible for medical underwriting support and proactive claims management for ASG clients.

 

 “I have always enjoyed the continuing challenge of assessing each case individually,” she said. “It requires daily research of new trends, new procedures and treatments and their costs, covering all health conditions.”

Sara brings more than 35 years of healthcare experience to our team, with 16 of those specific to the stop-loss insurance field.

“Our firm is recognized nationwide for our focus on high-touch customer service, which allows us to administer claims proactively while protecting employer interests,” said Peter Parent, President of ASG. “Sara provides our TPA and Broker clients with an experienced, knowledgeable resource for helping to control employer costs and achieve the best possible outcomes for everyone.”

 

 

On-Call with Sara Winand, RN

Friday, January 15, 2016
  • Welcome to ASG Risk Management’s On-Call Corner!

Because our goal is to minimize your policy risk, we think it’s important to provide as much information as possible about different conditions our employer groups encounter.

Feel free to share this page with your clients, or use it as a helpful resource for any condition you’re looking into.

 

What you should know about: Shingles

By Sara Winand, RN | Director of Medical Management

Shingles is a reactivation of the varicella-zoster virus, a type of herpes that causes chickenpox. After you have had chickenpox, the virus lies dormant in your nerve roots and remains inactive until it flares up. If the virus becomes active again, you may develop a rash that occurs only in the area of the affected nerve. This rash is called shingles.

Who is at risk for getting shingles?

– Anyone who has had chickenpox

  • – Those who have a weakened immune system, such as people with cancer or HIV

– People over 50 years old

– People who have been ill, suffered physical trauma or are under significant stress

– Those taking medication that affects the immune system, such as steroids

– Pregnant women who get chickenpox (A baby will have a high risk for shingles during the first two years of life.)

– Babies who get chickenpox in the first year of life

It is not clear why the virus reactivates in about 20% of those who have had chickenpox, but there is evidence to suggest a weakened immune system may cause the virus to reactivate, multiply and move along nerve fibers to the skin.

What are the symptoms?

– Itching, stabbing or shooting pain with tingling under the skin

– Flu-like symptom such as fever, chills, headache or upset stomach

– Helplessness and depression

– Rash that develops into blisters on one side of the body, often around the waistline or face. (These fluid-filled blisters usually dry and crust within seven to 10 days.)

How is it diagnosed?

– By associated symptoms such as presence of rash, blisters on one side of the body, pain, itching, or fever

– Lab analysis from scraping or swabbing of the fluid-filled blisters

Is there a treatment?

There is no cure for shingles, although it is important to seek medical evaluation early as treatments can help with associated pain and discomfort.

  • Antiviral medications such as Zovirax, Valtrex & Famvir may shorten the duration of the symptoms.
  • Pain medications, antidepressants and topical creams are also options to ask about.

Is it contagious?

Yes.

– People who have never had chickenpox and have not been vaccinated against the disease can develop chickenpox if exposed to shingles.

– Someone who has shingles can expose you to the virus if you have come into contact with the fluid in the shingles blisters.

  • – If you are have an outbreak of shingles, you can prevent the spread of the virus to others by covering any fluid-filled blisters that are not covered by clothes with a dressing that absorbs fluid and protects the sores.

Complications

– Delaying or not getting medical treatment may increase your risk for complications.

– Postherpetic neuralgia, or a pain that does not go away within 30 days after the shingles rash heals

– Disseminated zoster, where the blistery rash spreads over a large area of the body and can affect heart, lungs, liver, pancreas, joints and GI tract

– Scarring and/or skin discoloration

– Bacterial infection of the blisters

– Cranial nerve complications (if shingles affects these nerves), which cause impaired vision, intense ear pain, loss of movement of facial nerves and inflammation of blood vessels that may lead to stroke

– Muscle weakness in the area of the infected skin before, during or after the episode of shingles

Who should take the shingles vaccine?

The vaccine, Zostavax, decreases your chances of getting shingles by 51% and lasts about five years.

– People age 60 and older (The vaccine is FDA-approved for those age 50 and over.)

– If you already have had shingles (The vaccine may lower your risk of getting it again.)

– If you have never had chickenpox (You should talk to your doctor as there is a good chance that you don’t remember having chickenpox. Studies show that 99% of Americans over 40 had chickenpox at some point.)

You should not take the vaccine if you are allergic to gelatin or neomycin (an antibiotic) or have a weakened immune system.

Women who are or might be pregnant should not take the vaccine.

Got a topic you’d like more info on? Let Sara Winand, our Director of Medical Management (and registered nurse!) know what hot topics people are talking about. E-mail Sara directly at sara@asgrmi.com.

Sources:

WebMD

Medscape News & Perspective

Centers for Disease Control and Prevention


 

 

Disclosure Process: An Important Underwriting Component

Friday, January 08, 2016
  • Having a proper Disclosure system in place is a benefit for all parties involved: the policy holder, the TPA/broker, and the carrier. An accurate and detailed picture of all known claimants or high-risk individuals allows us to reflect potential exposure in the final policy.

It is the quality of the claims information in the disclosure that impacts everything from the way the policy is structured (including the premium calculated) to how efficiently a claim will be handled.

The following are a few ins and outs of ASG Risk Management’s Disclosure process.

What is Disclosure?

A process of revealing the known claim risk of an employer at point of sale.

Why do we do it?

To evaluate the potential claim liability of an employer.

  • Prevent unexpected claim disputes or liability in the form of claim reductions or denials.
  • Provide a firm rate quote that is accurate and fair.

How do we do it?

Review of TPA/vendor-generated claim reports from a clinical perspective. This includes the following reports:

    1. – 50% reports
    2. – Rx reporting
    3. – Case Management reports
    4. – Pended claims report
    5. – Precertification report
    6. – Individual medical applications (if applicable)

Visit our Forms page to download commonly requested forms.

When do we do it?

  • 60 days prior to effective date.

When is the policy locked in?

  • Upon confirmation of coverage placement and completion of the items outlined above.

Please note: locking in after disclosure review may require updated reporting.

 

Be sure to ask your ASG rep for more specifics. We look forward to serving you and your clients!

 

 

 

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