Case Study: Response To Mr. Maggio

Decent Essays
I am writing in response to Mr. Maggio’s inquiry to the Illinois Department of Insurance dated April 11, 2017. In the inquiry, Mr. Maggio expressed concerns regarding being enrolled in the incorrect health insurance policy and health insurance claims being denied.

Andrew, Rachel, Archer and Evelyn Maggio have coverage under the BlueCare Direct Silver 104 with Advocate Individual Health insurance policy effective January 1, 2017. The policy is currently active and paid through March 31, 2017.

After a review of the concerns presented in Mr. Maggio’s inquiry to your office, we have corrected our systems to properly reflect coverage for Andrew, Rachel, Archer and Evelyn Maggio under the BlueCare Direct Silver 104 with Advocate Individual Health insurance policy effective January 1, 2017.
…show more content…
Maggio and his family. Additionally, we reached out directly to the providers of the denied claims and have worked with them on resubmitting their claims for reprocessing. Upon reprocessing of the claims any applicable copayments, deductibles or coinsurance amounts will be properly credited towards the policy’s annual maximums.

We trust the information provided will allow you to satisfactorily respond to the inquiry. Should Mr. Maggio have any further questions, we encourage him to contact our office directly at

Related Documents

  • Improved Essays

    This case was brought by Mrs. Lucinda Bixler after the death of her husband, Vaughn. Mr. Bixler was employed by a company called Drivers who supplied truck drivers to local firms and was also a member of Teamsters Local 776. This union established a fund to supply members with medical, disability, and life insurance which the Bixlers were paying into and receiving benefits from. This fund is designed to accept contributions from the members of the union in line with collective bargaining agreements establishing a number of different levels of coverage. Mr. Bixler just happened to become ill during a time when the bargaining was at a stalemate and coverage was in jeopardy of being cut to the members of the union fund.…

    • 455 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    In order to fulfil the requirements of this course, I was required to complete a synopsis and full review of multiple Michigan Acts including the Michigan Public Act 593. My full review of this act for this course is included below. The Michigan Public Act 593 of 2006 (MCL 550.283) was effective on January 3rd 2007 allowed the State of Michigan the ability to identify and recuperate disperses payments from third parties that should always pay medical expenses primary to Medicaid. In order to identify beneficiaries that are enrolled in both the State’s Medical Assistance Program and other medical assistance policies or programs, the Michigan Department of Health and Human Services works directly with other payers to apply the National Roster File Process and…

    • 488 Words
    • 2 Pages
    Improved Essays
  • Decent Essays

    Thank you Madeline for the response. Also I review the claim for the patient Williams,Elmira DOS 02/29/2016 and I see that the claim missing the authorization number since the patient have as a payer St.Francis Life. Would you please review and add the missing information on claim. Please email back so I can add the authorization number on the original claim that I will Hold in Trizetto.…

    • 66 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    At the time of registration, the member/patient presented the hospital with a Medicare Part A & B insurance card. The hospital verified this insurance through the Passport system and then submitted its initial a claim to Medicare on June 11, 2014. The claim was rejected, and then the hospital learned that the patient was insured through SelectCare. Accordingly, the hospital promptly submitted a claim to SelectCare, but it rejected the claim due to a purported lack of authorization. SelectCare maintained its denial through two-levels of appeal by the hospital based on SelectCare’s position that the hospital should have checked the Medicare Common Working File to verify the patient’s insurance…

    • 441 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    In her appeal, Kontosis challenges the MIA’s determination the Hartford had not engaged in an unfair claims settlement practice. In support of her argument, Kontosis contends that it was an unfair claims settlement practice for Hartford to classify benefits received from the group policy and SSDI as other income under the association policy. Additionally, Kontosis alleges that it was an unfair claims settlement practice to seek reimbursement for the overpayment Hartford made as a result of not applying offsets under the association policy for the period that Hartford was not paying benefits under the group policy. Finally, Kontosis avers that the MIA erred when it determined that Md. Code (1995, 2011 Repl.…

    • 669 Words
    • 3 Pages
    Improved Essays
  • Decent Essays

    Mynexus Case Study

    • 196 Words
    • 1 Pages

    MyNEXUS has taken over managing the home health network in the state of GA for BCBS. The management of the authorization/case management was taken over by myNEXUS in June of this year. myNEXUS is currently moving all providers over to a new myNEXUS contract. The table shows our current HH rates, our proposed rates to myNEXUS and their counter. As, you can see their counter increases the rates for BCBS Commercial patients, however the counter from myNEXUS decreases the rates we will receive for Medicare patients and which is the bulk of our BCBS patients .…

    • 196 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    Whose Hospital Case Study

    • 1133 Words
    • 5 Pages

    Case Q: Whose Hospital? Background of the situation: In June of 1979, the medical staff at Brendan Hospital held a mass meeting at the hospital to discuss various allegations against CEO, Don Wherry. A petition was signed by half the medical staff and by half the employees of the hospital at the mass meeting.…

    • 1133 Words
    • 5 Pages
    Improved Essays
  • Improved Essays

    Cigna Benefits

    • 254 Words
    • 2 Pages

    Although the services for Cigna health plan are complex for some of its members there are such as member’s services that are available to those who are available to aid in giving information for finding in and out of network physicians for patients. “Gale Cengage Learning (2013) reports health insurance policies are contracts that require the insurer to pay benefits per the terms of the policy, in return for the payment of premiums and the meeting of other conditions or criteria spelled out in the plan. Payment of benefits (upon the occurrence of a qualifying event such as illness, injury, or office visit) may be reduced by a “deductible” paid by the insured, by a “co-insurance” payment shared with the insured, or by the reaching of a “maximum…

    • 254 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    Reg, To follow-up on our discussion from Friday, here are the specifics of the waiver conversation with Christina: The waiver will create a new program called AHCCCS CARE, which stands for Choice, Accountability, Responsibility and Engagement. AHCCCS CARE will apply to all able bodied adults. AHCCCS estimates this to be between 250,000 and 350,000 members and touches all of the current eligibility categories, e.g. Proposition 204, Restoration, Expansion, and traditional Medicaid. Also, members in the GMH/SA group will be included but AHCCCS CARE will be optional for the SMI population. Some exclusions do exist for DD, ALTCS, KidsCare, and eligible caregivers.…

    • 636 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    The Dos and Don'ts of Medicare So your birthday is right around the corner, and this year that means you're ready for Medicare. It does, doesn't it? Are there requirements other than age? Where do you even sign up?…

    • 615 Words
    • 3 Pages
    Improved Essays
  • Superior Essays

    The passage of the Affordable Care Act into law by President Obama in the year 2010 carried with it a myriad of blended responses among Americans. As much as the law is viewed by numerous as a noteworthy policy feat in the United States, there are the individuals who oppose this idea. Six years down the line, the open deliberation about the issue of the Affordable Care Act does not appear as though it is leaving at any point soon. Individuals from various background differ on the grounds of health care access, use and the outcome and the results of executing the utilization of the law (Cutler, 2015). To date, determined absence of information and utter disregard of the law have ended up being very testing to the general usage of Obamacare.…

    • 1498 Words
    • 6 Pages
    Superior Essays
  • Great Essays

    TRICARE in a Nutshell TRICARE is the United States Department of Defense (DOD) Military Healthcare System. TRICARE provides military personnel, both active and retired, along with their dependents, a civilian health benefits. The program also covers survivors and certain former spouses worldwide. Finally, in the same way active duty or retirees become eligible, certain reserve military members and their direct dependents become entitled on the service member 's 60th birthday (DHA 1). This paper will further discuss the company’s history, available insurance products, organization, number of enrollees, and financial breakdowns.…

    • 1603 Words
    • 7 Pages
    Great Essays
  • Superior Essays

    The Affordable Care Act took almost a year to pass through Congress. It sparked heated debate and resistance from Republicans. Republican leaders argued the bill infringed upon American liberties while Democrats said the bill improved social justice and the lives of the citizenry, especially the 45 million uninsured. People who once could not find an insurance provider because they suffered from a previously diagnosed illness or people who were dropped by a provider due to an illness, now had the opportunity to be covered by insurance at an affordable rate. Republicans feared that the act would be costly to the United States as it was always ready facing a deficit.…

    • 1234 Words
    • 5 Pages
    Superior Essays
  • Improved Essays

    Anthem is a health insurance that provides multiple benefits and quality services to its customers. The history of Anthem started off with two separate companies, WellPoint Health Networks Inc. and Anthem Inc. Both companies merged in 2004 and became the nation’s leading health benefits company (Anthem, 2015). “The Anthem brand is built on a foundation of trust – it’s the name consumers are most familiar with as a trusted health care partner through our affiliated health plans” (Anthem, 2015, para. 1).…

    • 737 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Healthcare Expensive Essay

    • 1122 Words
    • 5 Pages

    “An estimate done by the Census Bureau’s, said that thirty-three million Americans lacked health insurance in 2014 reflects a significant and welcome drop from the forty-two million it reported as uninsured in 2013,” said Dr. Robert Zarr, president of Physicians for a National Health Program, today (More Americans gain health coverage, but many can’t afford to use it: doctors group). In this time of rising health care costs, a great amount of Americans experience troubles or difficulties paying for needed health care services. With the costs that are expected to continue rising, changes happening to private insurance plans and public…

    • 1122 Words
    • 5 Pages
    Improved Essays