Historical Newspapers of South Carolina

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Benefits Out-patient surgery lowers costs Did you know there are several steps Clinton employees can take to help them use their health care benefits more wisely and in more cost-effective ways. These services are provided for in Clin ton's Group Health Insurance Plan. Outpatient Surgery... Clinton Group Health Insurance Plan provides hospital benefits for outpatient surgeiy performed in a hospital's outpatient department or ambulatory center, and no deductible is required. In effect, the plan will pay 100 percent of the reasonable and customary charges by the surgeon for surgical procedures performed in the out-patient department of a hospitals ambulatory surgical center. A number of surgical procedures considered too serious to perform in a doctor's office, but not serious enough Insurance Q&A 1, Q. When I have claim forms amounting to a sufficient number to file, how do I go about submitting them? A. Take them to the Personnel Department, but you need to complete the employee part of insurance form and attach a claim before leaving them at Personnel Dept. Do not mail claims directly to Provident, as they will send them back here before processing. 2. Q. My wife and I both have dependent coverage (double coverage). Does this mean my insurance will always pay my medical charges? A. No. Double coverage means that if one plan is obligated to pay $25 on a charge, then the spouse's insurance will pay up to $25 or 100 percent of charges. If you go to the doctor's office or emergency room for sickness and your charge is $50 and your insurance pays nothing because it is covered only under major medical, then your spouse's insurance would not pay anything at this time. 3. Q. My daughter is pregnant, will my insurance cover her on maternity? A. No. It covers only employee or spouse on maternity. to warrant admission to a hospital are now being performed on an outpatient basis or in the ambulatory surgical centers. This can result in a very significant reduction in costs. Some operations that can be performed on a one-day basis include tonsillectomies, simple hernia repairs, vasectomies, removal of noncancerous cysts, some cosmetic surgery, minor gynecological procedures, even cataracts. In addition to saving money, outpatientand ambulatory surgery can free hospital beds tor persons more seriously ill. In fact, the development of ambulatory surgical centers may be an alternative to expansion of inpatient facilities in areas where there is needed for additional capacity. Many procedures can be per formed in the facilities available in Laurens County. Pre-admission Testing... While everyone would like to avoid hospital confinement, this is, of course, impossible. However, we can try to shorten the time and money spent in the hospital through pre-admission testing. Pre-admission testing means providing certain services such as X- rays and laboratory tests on an outpatient basis prior to a scheduled hospital admission. Until recently, it was common practice to hospitalize patients for these test, thus increasing Claims procedures changed In an effort to contain our health care administrative costs, it has been necessary that we improve our procedure for handling Prescription Drugs and Doctor'sOfficeVisitClaims. PROVIDENT makes a charge to us for each health insurance claimed processed, regardless of the amount of the benefit payment and even if there is no-benefit payment. In some instances the cost of an Explanation of Benefit Statement (EOB) equals or exceeds the amount of a small claim. Employees should observe the following procedures for filing claims: 1. Claims should not be submitted for Prescription Drugs or Doctor's Office Visits until the $200 deductible has been satisfied. If a claim(s) are received and the $200 deductible has not been satisfied they will be returned to you, the insured. 2. Once the $200 deductible has been satisfied, additional claims can be submitted, but only when they exceed $50. Claims not meeting this requirement will be returned to you. 3. Claims that do not exceed $50 can be filed at the end of each calendar quarter (March, June, September, December). 4. If your spouse is employed with another company and his/her group plan pays as primary on him/her or pays primary on a covered dependent child, you will be required to submit a copy of the primary carrier's Explanation of Benefits (EOB) along with theclaiminorderfor PROVIDENT to coordinate your benefits with his/ her benefits. As customary, the following types of expenses should be filed immediately by you or the provider of the service. 1. Claims for treatment of a non- occupational injury. 2. Qaims for out-patient diagnostic laboratory and x-ray examinations (DXL). 3. Claims for pre-admission testing (PAT). 4. Qaims for second surgical opinion. 5. Claims for surgery performed on an out-patient basis. 6. Qaims for any medical expenses forwhichyouhaveauthorized payment directly to the hospital or doctor. If you have any questions or desire any additional information regarding the subject, please feel free to call Mr. Truman Owens in the Personnel Office. Contributions matched booster clubs, or similar dues and payments. Under the Matching Gifts to Education Programs, the Company will match eligible gifts up to $2,000 per employee during any one calendar year. The employee's contributions must be in the form of cash or securities havinga quoted market value, and paid directly to the qualifying institutions. Eligible gifts of $50 or less will be matched on a two for one basis. Clinton Mills will notify each employee when the matching contribution is matched. the length of time spent in the hospital. Pre-admission testing is especially appropriate in case of elective surgery when a battery of presurgical tests are required, with testing done in a hospital's outpatient facilities. Pre-admission testing programs offer the potential for reducing both the cost per hospital admission and time lost from work... be sure and ask your doctor if and when the need arises. Pre admission testing performed on an out- patient basis prior to hospital confinement will be covered at 100 percent if such testing is performed within five days confinement. In Conclusion... Outpatient surgery, pre-admission testing and use of the diagnostic examinations benefits are just a few of the ways Clinton employees and their dependents can help reduce the cost of health care, both for themselves and for their company. Be sure to discuss with your physician these ideas, and do your part in insuring that you have the best possible health care at the lowest possible cost. Insurance payable to beneficiary Your life insurance is payable to your beneficiary in the event of your death while you are insured under the plan. You may name anyone as your beneficiary and you may change your beneficiary at any time by completing a change of beneficiary form. It is important this information be kept current. If you would like to know who you have named as your beneficiary, you may do so. However, to assure absolute confidence, this cannot be handled by telephone and can only be released to the insured. You must come by your personnel office and an insurance co-ordinator will be glad to share this information with you and make changes if necessary. You may also want to check on your medical coverage to make sure your eligible dependents are covered, and you are not paying premiums for ineligible dependents. iM ClothMaker