ASG Perspectives

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!

 

 

Spotlight: The Diversified Group of Companies

Wednesday, December 02, 2015

For those of us in the risk management business, we know our work involves keeping up with the changing landscape of health insurance and employee wellness on a daily basis. Offering great customer service and encouraging an attitude of flexibility throughout our office are just a couple of variables that can mean the difference between being a good partner or a great partner.

That’s why we feel we’ve been so lucky to work with companies like Diversified Group of companies over the past 10 years. Based in Marlborough, Conn., this TPA firm is all about keeping up with the latest in employer health benefits while consistently delivering accurate and efficient benefits administration services.

When we were first introduced to Diversified, we immediately hit it off – after all, this is a company that invests its time professionally as well as personally, just like we do. Also like us, they take pride in being able to figure out a way to get what needs to be done, done – and always with a can-do attitude. (We like the idea of putting a smile in our voice, too!)

While Diversified Group has been administering self-insured health plans for more than 45 years, its three principals today are Brooks Goodison, Charlie Soleau, and Dan Sousier. Altogether, the company has a great track record for providing a very comprehensive and cost-effective approach to self-funded healthcare for businesses throughout the country.

In a recent conversation, Brooks noted that his company successfully accomplishes all this while competing in a fairly big pond. With competition from Blue Cross and Aetna to Cigna, Harvard Pilgrim and plenty of big names in-between, Diversified knows that if they’re not on their game, they’re going to be out.

So how to keep those big guns at bay? For Diversified Group, a critical differentiator is customer service – specifically, dedicated in-house teams focused 100% on service continuity. That sounds like a big commitment, but according to Brooks, Diversified Group is actually in a unique position to offer more flexibility and responsiveness than the larger companies because of its status as an independent company. With all customer service in-house, the firm can deliver a more cohesive, focused and experienced support tool and remain dedicated to working one-on-one with clients.

That level of personalization and dedication have paid off. Brooks notes the company has clients that have been with Diversified Group for more than 30 years, and average client retention is around 10 years. Its average employee group size is 110 employees, whereas the largest is 3,500 employees.

Plans for continued success won’t be slowing down any time soon, either. For example, a rapidly growing division of the Diversified Group is its Corporate Health & Fitness, which helps employers create worksite wellness programs such as one-on-one health screenings. This is an area where businesses are more and more frequently looking to actively manage the impact of healthcare costs on their P&Ls.

According to Brooks, one of the best ways to help ensure a positive outcome – financially for employers, and in terms of physical health for employees – is to keep the spotlight focused on health and wellness from within. He notes, “We believe heavily in worksite wellness and helping companies manage their health insurance costs. Know your cholesterol and physical numbers – and make sure the clients that are self-insured understand the limits of that risk.”

One trend that Brooks points to as becoming more prevalent today is helping companies manage the costs of specialty treatments new to the market. High-dollar infusion therapies, pharmacy claims and specialty drugs can cost upwards of $150,000 a year – and that cost could last as long as an employee’s life.

It’s a challenge for a business of any size, he concedes; but providing knowledgeable self-funding information and strategies to help clients budget for such costs – including the right stop loss controls – allows Diversified Group to help companies foster happy, healthier workforce groups while staying in control of their bottom lines.

If you’d like to learn more about Diversified Group, click here to visit the company’s website. 

 

Cleaning up on Claims: The Clean Claim Checklist

Monday, November 02, 2015

by April St. Cyr, Claims Manager

At ASG we call a claim a “clean claim” when it has everything we need to begin processing the claim. That sounds simple enough, and our clients are usually great about covering all the important bases. For our part, we strive to achieve a 10-day turnaround from the time a claim is received until the time a check is issued.

In fact, our team is proud to report that in 2015, ASG averaged a 4.5 day turnaround for claims! 

In an ongoing effort to work in concert with our partners, we feel it’s important to prioritize all Advance Funding requests. We also do our best to work with the TPA on a request that has a required payment timeframe due to negotiated discount.

ASG is committed to providing the highest quality services and delivering products that allow our TPA partners’ clients to control costs. To help us continually improve the effectiveness and efficiency of the claims process, be sure to include all of the items on the following Clean Claim Checklist When preparing to submit a claim.

Clean Claim Checklist

-Eligibility

-UB and itemization for all claims over $75,000

-Applicable precerts

-Paid claims report

-Case management notes

-Proof of deductible and out of pocket

-Eligibility inquiry (completed by employer)

-Specific reimbursement form

Click here to download our complete Claims Manual.

Missing information

As we all know, it is sometimes difficult to submit everything with the initial filing of the claim. Be assured that ASG will process the claim and follow up with the TPA every week for missing information. It is important to get the required information to us as soon as possible so we can issue a check. Once the missing information is received and everything is in order, we’ll review and release for a claim.

Check processing

We schedule a check run for claims once a week. If more convenient, ASG also offers ACH (wire) transfers of claim payments in place of sending a check.

April St. Cyr brings 16 years of experience in the MGU/health insurance business and four years in employee benefits to her role as ASG Risk Management’s Claims Manager. Formerly our Claims Analyst, April finds the ever-changing insurance industry interesting and full of learning potential. She attended Husson College and graduated with a BS in Business Administration.

Meet our Underwriting Assistant: The Go-To for Good Connections

Thursday, October 01, 2015

By Andrea Melone, Underwriting Assistant

As ASG’s Underwriting Assistant, I function behind-the-scenes in support of the high quality work our company stands for. When it comes to handling sold cases in particular, my job involves routing critical information between the appropriate people in our company and our TPA, broker and consultant partners. Another big part of my job is making and maintaining connections to ensure consistency, organization, security, and solid relationships.

Communication is an essential component of my day, which involves forming relationships with our business partners to ensure the correct information is passed on with continuity and consistency. My role as the “go-to person” means that the processes for policies and applications, including follow-up reminders, develop a rhythm and run smoothly. TPAs, brokers, and consultants expect to hear from me and can come to me regularly.

I take a lot of pride in keeping everything organized. My job is comprised of maintaining the system for policies, making note when a policy package is issued, and being the person to contact when expecting the policy; with this system, I’m able to let our partners know whether or not we’re missing any items and when they can expect their policies. Good organization lets producers and TPAs know their valuable information will make it to the right place and that sending them requested information is a priority.

I also provide security for our clients, acting as the safeguard for confidential documents. I feel it’s important to protect the information and ensure it gets to the right person. Instead of scattering through multiple outlets, I prevent holes—so instead of letting vital information and sensitive documents slip through the cracks (or land into the wrong hands), files remain confidential and our team is able to ensure that the appropriate people receive data and documentation. Our clients can trust that I will not open any documents myself, and that only those for whom the information is intended will see it.

Possibly the most significant aspect of how I function in this business is my ability to develop and maintain relationships. Because our TPA and broker partners know I am here for them, I’m able to continue to develop and strengthen their trust in ASG. Relationships are obviously crucial to any business, and with us, positive and friendly exchanges help us all work together effectively. Communication regarding sold cases, such as follow up notices, is never with a complete stranger—instead, our partners know there is a familiar voice on the other end of the line. I’m very proud to provide an important role that lets TPAs and producers feel confident and comfortable with our team and our services.

As a valued member of the underwriting team, Andrea Melone is responsible for claims and administrative duties required to support client, broker and TPA relationships. She graduated from Western New England University with a BA in Creative Writing in 2013 and is a resident of Portland, Maine.

Meet the entire ASG team. 

Putting “Custom” in Employee Benefits

Wednesday, September 02, 2015

ASG Risk Management and Custom Design Benefits have an extensive history working together, and we continue to be thrilled with the value this trusted partner offers with every interaction.

Custom Design Benefits is a TPA based in Cincinnati, Ohio, offering tailored employee benefits administration services to employers throughout the U.S. Among the company’s portfolio of services is a wide range of self-funded health and wellness solutions.

As an MGU that prides itself on personalized solutions, we particularly like that Custom Design Benefits operates from the same tenets of creativity and integrity that align with our firm's values.

A Personal and Caring Approach

Custom Design Benefits’ president, Julie Mueller, is a shining star in our industry. With at least 30 years of experience in the TPA industry, she is personally dedicated to finding creative ways to contain costs for her clients. She has no fear! If she knows what’s right, she’ll go out and do it – which is likely why she and her firm are regularly recognized as national leaders.

This attitude becomes obvious when it comes to the company’s customer service – those “above and beyond” types of things, like making clients aware of what’s new and innovative… or the firm’s policy of personally meeting with every client on a regular basis. Plus, the team at Custom Design Benefits has multiple years of experience providing self-funded clients with services; they know what they’re doing.

With 55 employees and growing, it can be a challenge to maintain what the company calls an “extreme commitment to quality” – yet Custom Design Benefits sets the bar high and actually embraces the challenge.

Quality standards are in fact above industry standards for policies and procedures that people involved in the administration of benefits must follow. Operational metrics are monitored and measured continually – most recently resulting in 99.99% financial accuracy (meaning that every $100 an employer spends on its health plan is accountable to the penny).

Customization and Control

The company offers an interesting product that truly stands out from other TPAs in the marketplace. Its TrueCost Reference-Based-Pricing Plan is predictable and allows for a win-win-win scenario for all involved:

Employees have the flexibility to choose their provider as informed healthcare consumers, responsible for a co-pay only (no deductibles and no coinsurance).

Employers implementing this self-funded plan can reap significant savings and bring predictability to one of their most significant expense items

  • Providers are reimbursed fairly, consistently and in a very timely manner, eliminating the need to allocate precious resources toward accounts receivables and debt collection.

Custom Design Benefits also features direct contracts with local hospitals and independent physicians, giving employers a choice of hospitals. In turn, this structure gives the hospital the opportunity to do business directly with their clients – local employers – without having to go through the PPO network.

We are proud to partner with a company that sets high standards for plan management while continually making stop-loss insurance easy for employers to understand and use.

Interested in finding out more about this great partner? Visit www.customdesignbenefits.com or call 1-800-598-2929.

 

We’ve Moved Our Office!

Monday, August 24, 2015

It’s official – as of last week, ASG Risk Management is located one floor downstairs in beautiful and bright new offices.

We’re thrilled to welcome our valued TPA or Broker visitors and invite you to make yourselves comfortable while taking advantage of the latest technology in one of our spacious conference rooms.

For our employees, the new space allows people in various departments to consolidate near each other, making communication more efficient and workflow more streamlined.

And of course we love being steps away from all that beautiful downtown Portland, Maine has to offer, including an active business community, great restaurants, and historic old port district.

What could be better? Visit us next time you’re in town and we’ll show you all around!



Our New Address:

ASG Risk Management, Inc.

Fourth Floor

2 Monument Square

Portland, ME 04101

EndFragment

Inside ASG: This Summer’s Goings-On & Adventures

Friday, July 31, 2015

It’s official: This past quarter has officially been our busiest ever. The other day, Peter Parent, our company President, commented that moving at 100 miles an hour is a whole lot better than not moving at all – and he couldn’t be closer to the truth!

We are excited to share a few highlights of recent happenings here on MGU Perspectives. Check back for “Inside ASG” news often!

---------------------------------------------------------------------------------------------

Companion Life Insurance Co. Named to National Top 50 List

As an affiliate partner to Companion Life, we are thrilled whenever our parent company is recognized by the medical stop-loss industry. After all, Companion’s success translates directly into success for every one of ASG‘s valued customers and partners.

The company recently released the following exciting announcement:

Columbia, S.C., July 27, 2015 – The business consulting firm Ward Group has placed Companion Life Insurance Company on its list of the nation’s top 50 performing life and health insurance companies for the fifth consecutive year.

Cincinnati-based Ward Group, a provider of benchmarking and best-practices services to the insurance industry, annually analyzes the financial performance of hundreds of life and health insurance companies domiciled in the United States to identify the top performers. The group announced the Ward’s 50® in a news release.

Each Ward’s 50 company has passed all safety and consistency screens and achieved superior performance over the five years analyzed, Ward Group said.

“In selecting the Ward’s 50, we identify companies that pass financial stability requirements and measure their ability to grow while maintaining strong capital positions and underwriting results,” said Jeff Rieder, president of Ward Group.

“Companion Life strives for best practices in all our product areas. It’s an honor to be recognized by an independent, external organization that knows our industry,” said Scott Hinton, Companion Life president.

---------------------------------------------------------------------------------------------

The ASG Team Takes a Time-Out

On July 23rd, our team attended a unique development day on Cow Island, located off the coast of our beautiful home town of Portland, Maine.

In addition to participating in a variety of activities and exercises, we had a blast simply being together and away from the paperwork and technology of everyday business. We returned energized and excited about the infinite possibilities for our company and our valued customers and partners!

The team was excited and ready to get out on the water early.

 

Teri Cookman and Mike Tushman left the city behind.


We kicked off the day on the island with a group exercise geared toward enhancing communication and setting goals.


Team Awesome vs. Team Greatness

A highlight of the day was participating in a raft building adventure. We were broken into two teams, which we named Team Awesome and Team Greatness. Team members were assigned job titles such as executive director, purchasing manager, or marketing coordinator. After “purchasing” materials and building our rafts, assigned paddlers from each team were tasked with delivering a lifesaving “vaccine” to a nearby island. 

Teams first gathered on the beach to set up for the ultimate challenge.

 

Team Awesome’s raft was questionably seaworthy....


... yet Faye Nelder remained optimistic that her team would prevail. (It did!)


Mike Holland and Nate Savage of Team Greatness headed back to shore – not necessarily successful in their mission but smiling nonetheless!

Our retreat was hosted by Rippleffect, a non-profit youth and community development organization based in Maine’s Casco Bay. Rippleffect’s staff have decades of expertise in leadership training, experiential education and adventure recreation – and everyone we dealt with was beyond exceptional. 

We’re looking forward to keeping the “Team ASG” ball rolling and hosting Rippleffect at our headquarters this fall for ongoing leadership development and team building. 

--------------------------------------------------------------------------------------------- 

Best Wishes to One of Our Industry’s Best


Our Maureen Moriarty will retire on August 31, 2015 from her position as ASG’s Risk Management Specialist. With more than 40 years of experience in the health insurance industry, Maureen has always done a fantastic job keeping claim dollars under control for our customers. She is recognized as a real pro by the industry and we are proud of her contributions to our company. 

Maureen plans to spend time her husband Dan and their children and grandchildren. Good luck Maureen!

The Underwriters’ Perspective: The Building Blocks of a Strong Policy

Wednesday, June 10, 2015

By Sue Peebles, Underwriting Manager & Maggie Moynihan, Senior Marketing Underwriter

When it comes to underwriting a group of any size, there are many things that come into play, and a few key attributes are critical to success. Working together with a broker and/or TPA to meet the client’s needs, returning calls promptly, and consistently making due dates are just a few basics we keep in mind on a day to day basis. But a good foundation of knowledge and experience is essential when it comes to actually getting the job done.

A strong underwriter understands the importance of customer service, but additionally has complete understanding of group health insurance, ACA, managed care, HIPAA, and risk evaluation, along with the different roles played by TPAs, brokers, BUCAs, MGUs, and others. A lot of this experience comes from on the job training, and common sense should not be underestimated. The number of years someone has been underwriting also comes into play.

The ability to partner with a broker, TPA or consultant in a constructive manner is another key attribute developed over time. ASG is able to pride itself on these long-standing relationships that have been built. Our commitment to partnership has only become stronger over the years, as we continue to work closely with leading professionals who work from the same values.

Read more about Independent Insurance Marketing Executive Nancy Ferrell, a valued ASG partner for more than two decades. 

An important aspect to a strong underwriter is recognizing a good risk when it’s presented, combined with the willingness to go the extra mile in order to write the group. Taking the time to look over different options with the broker and/or TPA can be well worthwhile in the long run. Determining a common goal is the first step.

Working efficiently to get the job done and respond appropriately in a stressful, high volume environment comes with years of experience and again a strong foundation. Strong communication skills, also developed over time, are absolutely critical when it comes to developing partnerships and creatively closing business deals.

In addition to experience, what it really comes down to is integrity, honesty and transparency. These are the principles that ASG was founded on and that we continue to strive for in everything that we do.

Sue Peebles manages all underwriting, underwriter and support staff development, and RFP and renewal activity for ASG. With more than three decades of experience in group health insurance, she is an expert in the stop-loss field.

Maggie Moynihan works closely with our claims and marketing departments to evaluate employer stop-loss quotes while also building and maintaining relationships with brokers and TPAs. Maggie began her insurance career with ASG in June of 2006.

Meet the entire ASG team.

Spotlight: Someone You Should Know

Monday, April 27, 2015

Long before we opened our doors for business, our founders had worked in the insurance industry for some time—learning about insurance, developing relationships, and discovering what worked (or didn’t work). For ASG, our goal was to deliver a superior product by offering unequaled customer service and accessibility.

We knew inherently that only by working with the right people would we be able to deliver on those values day in and day out. That’s why the heart of our company is not necessarily the policies we write, but the partners we work with… those relationships that have stood—and will continue to stand—the test of time.

Click here to learn more about our Dedicated Client Service model

Meet The Farrell Group

 

Nancy Farrell

As an Independent Insurance Marketing Executive based in Goshen, KY, Nancy Farrell has carved a successful niche in the business, thanks to her ability to identify the best Managing General Underwriters and carriers to meet the needs of her clients—who she always puts first.

Serving as a single point of communication, she is very adept at helping her partners on both sides of the desk navigate through the most complex of transactions. For more than 25 years, Brokers and TPAs have been coming to Nancy to source medical plans and benefits for employer groups of 20-plus lives.

And she knows her stuff.

Nancy began her career working full-time for Commercial Union Insurance Company while earning a BS in Business Administration (with a concentration in Marketing) from the University of Louisville. A licensed Life and Health Consultant, Nancy was recognized in 1986 as the youngest person in the state of Kentucky to earn the Chartered Life Underwriting® degree.

Her passion, work ethic and commitment to excellence have distinguished her entire career. Constantly striving to deliver unparalleled long-term customer satisfaction, Nancy truly understands her clients’ challenges and works creatively and diligently to solve any problem they may have.

She’s the real deal, with an ethic that has provided an exceptionally strong foundation for our decades-long relationship.

Like us, Nancy believes that in a world where everything seems to be online and business is done through apps, there’s still nothing like picking up the phone. The human factor plays an enormous role in the work we do together and, in our view, our many years of mutual success.

As she notes, “You can’t snap your fingers and make things happen! You have to rely on trust in buying and selling, and to do that, communication is everything. With ASG, we’ve got each other’s backs—and that translates into peace of mind for my clients.”

If you’d like to speak with Nancy directly, just pick up the phone and call! (502) 292-3303

The Golden Rule Behind the Best Stop-Loss Policies

Monday, April 06, 2015

We’ve been noticing the word “integrity” being used in our industry:

“Integrity is at the core of every relationship.”

“We do business by adhering to the highest levels of integrity.”

And so on.

But what does that really mean, particularly within the context of a risk management company?

At ASG, we call ourselves “your stop-loss insurance partner” and for us, that phrase is so much more than a tagline—it’s about the relationships and the values that our business was founded on. It means the promises we make are the promises we keep. It’s in the people we hire and the level of service we deliver every day. It’s about the integrity that supports every relationship, new and old.

It’s a crucial cornerstone of our business, and has to be as solid as the granite rock our office’s foundation sits on.

For example, we all understand there are long-term implications to offering a quick sale. What happens when a carrier “buys business”—that is, offers a dirt-cheap premium then jacks up the rate the following year—is the complete opposite of working with integrity. It astonishes us that companies are willing to alienate their clients and undermine their credibility for a quick sale. In this business, referrals are everything and if we make our TPA or broker clients look bad, then it’s only the tip of the iceberg to making the entire industry look bad.

The exact opposite of working with integrity is failing to:

-Stand behind our product

-Offer personal customer service

-Support our partners’ businesses

You hear it all the time, but customer service really is the key to success. We’re proud that ASG has grown slowly and steadily, and we recognize we’ve been able to do that by committing to a few crucial best practices, all within the context of operating with integrity. We’ve learned that the best way to differentiate ourselves with TPA and broker clients is:

- Through the quality of the work we put out

- How responsive we are

- How accessible we are

It’s deceptively simple. Why ask you—an insurance professional operating in your local community—to put your reputation on the line and stand behind our product, without standing behind you? Why require you to make a million phone calls to resolve an issue, or wait 72 hours for someone to respond to your call? These practices and more only work to chip away at the integrity of our relationships and make life hard for everyone.

At ASG, we prefer to embrace the golden rule: Treat people the way they would like to be treated—with integrity!

From widget makers to retailers, consultants to salespeople, a lot of people lose sight of that guiding principle. We know that if we buy business, we lose business—so we just don’t. It hasn’t been through acquisitions or buying business that we’ve grown; it’s been by slowly establishing and valuing loyal, sustainable relationships. To us, that’s operating with integrity.

 

Innovative Products. Personalized Services.

Solutions for YOUR Business.

Let’s talk about protecting your clients’ self-funded health plans.

 

Submitting Form...

The server encountered an error.

 

Captcha Image

Submitting Form...

The server encountered an error.

 

©2016 ASG Risk Management, Inc. All Rights Reserved. Privacy Policy. Site Map. Website by www.atompie.com