Law Enforcement Health Benefits Inc.

2233 Spring Garden Street 19130 | Philadelphia Pennsylvania | 215-763-8290

John J. Gaittens, Administrator

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2018 COB/HIPAA Forms

Frequently Asked Questions

Question: Why do I have to fill out this form every year?

Answers:

  1. It is required by the FOP/City of Philadelphia contract, Section VII. Health and Welfare, E. Coordination of Benefits. The form must be returned even if there is no other insurance coverage.
  2. Coordination of Benefits is required by the Pennsylvania Insurance Commission.
  3. Coordination of Benefits keeps our costs down.
  4. We need the signed form to handle any billing issues you might have. Without a signed HIPAA release form we cannot handle any of your bills.
  5. All forms must be returned by DECEMBER 31, 2017.

Question: Why do my spouse/adult dependent(s) have to fill out the HIPAA form every year?

Answer:

  1. Without the signed HIPAA release form, no provider or facility will discuss any billing issues you send in to LEHB to handle for your spouse and adult dependent.

Question: Do I have to initial the Mental Health and Drug/Alcohol portion of the form?

Answers:

  1. Independence Blue Cross requires a signed HIPAA release for the spouse and adult dependent for us to be able to discuss billing/treatment issues.
  2. The specific language is mandated by the Commonwealth of PA.
  3. We do not release this information to anyone.
  4. You, your spouse and/or adult dependent are not admitting to having these problems, it is only an authorization in case the need arises.
  5. We need the relevant initials in this section in case you, your spouse or adult dependent need any services in the upcoming year to discuss treatment with the facility. If the need arises, Magellan will not assist us in obtaining a facility without the signed HIPAA form.

Question: Do I need to obtain a letter from my spouse's employer stating that he/she does not have insurance?

Answer:

  1. Yes, we need confirmation, every year, of the waived insurance or non-availability of insurance through the spouse's employer.

Question: What if the information on my form is incorrect, can I write the correct information on the form?

Answer:

  1. Yes, you can simply draw a line through the incorrect information and write the correct information on the form. However, if the incorrect info is due to an address change, divorce or name change, you need to call LEHB and request the proper change forms.

Question: : Do my spouse and adult dependent(s) have to sign their own form?

Answer:

  1. Yes, a separate form is required for the spouse and adult dependent(s).

STAY IN-NETWORK! DON'T LET OUT OF POCKET COSTS AFFECT YOU OR YOUR FAMILY MEMBERS!

As you know, Police Officers make it a habit to be aware of their surroundings and to constantly evaluate locations and situations for threats. It is unfortunate that the same mindset should be used when dealing with healthcare providers and facilities.

The best advice we can offer to avoid large out of pocket expenses is to stay in the Blue Cross network. If you refer to the LEHB website, www.lehb.org look at the Blue Cross Blue Shield Summary of Benefits and Coverage, click on "Summary of Benefits 2017" you will see that if you stay In-Network, there is NO deductible and the plan pays 100% of the costs unless otherwise noted.

However, if you go Out of Network, you will be subject to a deductible ($500.00 for Single and $1,000.00 for Family) additionally, the plan will only pay 50% of the In-Network allowable rate. The following simplified example will demonstrate how your costs could be significant. (This example does not include lab fees and other customary charges which can be very significant).

A member's adult dependent goes to an out of network addiction treatment facility. Their charge per day is $2,548.16 times 30 Days for a total cost of $76,444.80.

IBC will pay 50% of the In-Network daily rate. The daily In-Network rate is $454.00, 50% is $227.00 times 30 Days equals $6,810.00 The member will be charged the $500.00 Deductible, leaving $6,310.00

The Out of Network facility charged a total of $76,444.80 IBC would pay $6,310.00. The Out of Network facility could "balance bill" the member $70,134.80

NOTE: Per the Affordable Care Act, the balance-billed portion of your out-of-pocket expenses won't be credited toward your out-of-pocket limit.

Therefore, the member could be responsible for the full balance of $70,134.80

Specific Terminology: Always ask the Provider or the Facility if they are IN the Blue Cross Network. Some Providers/Facilities try to mislead the member by saying "we accept Blue Cross" or "we accept all insurance." That does NOT mean that they are "In Network" or will accept the Blue Cross payment as payment in full. You would be subject to pay the balance.

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