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Fix your claim problem – before it happens

There are 5 steps to fixing your claim problem – but most people don’t follow them.  By the time claim problems get to our office, they are usually months old, and huge issues.  So here is the best way to handle it, in this order:

  1.  Don’t ignore your mail.  Read those bills from doctors, explanation of benefits and especially collection notices.  Ignore these at your peril as they will only get bigger.  Ignore them long enough and they will hurt your credit.
  2. Do Something – If the claims look wrong, if the bill isn’t paid right – do something.  If you get a collection notice – do something now!  Who to call?  Collection notice- Call the collection company.  Bill – call the hospital or doctor and find out if they submitted it to the insurance carrier.
  3. Call the insurance company.  The numbers right on your card, easy-peezy.  Except for the 45 minutes of listening to the tape of “your call is important to us…”  Truth is, almost all claim problems are the result of minor coding errors and can be resolved with one phone call to the insurance company.
  4. Take Great Notes- Not good notes – great notes.  Time you called, number you called, who you spoke to, their extension, what they said to you exactly.  Especially if they tell you something is approved, or covered – we made need these later.
  5. Call your broker-  This is a last step, because it involves a lot – you have to sign a HIPAA release form for us to look at it, then send us all your documentation and notes, and then we can discuss.  If you are our client, we will usually appeal the claim for you – if it appears that things have not been processed correctly.

The appeals process has several steps, prescribed in your contract, that must be followed.   It tends to be a lengthy process, often taking months.  The best way to avoid this is step 1 – please read and react to your mail right away!

HSA and FSA Limits for 2018 announced

Salary Reduction Annual Limit
Employee contributions to employer-sponsored health flexible spending arrangements (FSAs) will increase to $2,650 (up $50 from 2017).

2015 2016 2017 2018
Salary Reduction Annual Limit $2,550 $2,550 $2,600 $2,650

Annual Contribution Limitation
Self-only coverage under a high deductible health plan is $3,450 (up $50 from 2017). Family coverage under a high-deductible health plan is $6,900 (up $150 from 2017).

For calendar year 2018, a “high-deductible health plan” is defined as a health plan with an annual deductible that is not less than $1,350 for self-only coverage or $2,700 for family coverage, and annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) that do not exceed $6,650 for self-only coverage (up $100 from 2017) or $13,300 (up $200 from 2017) for family coverage.

2015 2016 2017 2018
Minimum deductible amounts for the qualifying high-deductible health plan (HDHP)
Individual coverage $1,300 $1,300 $1,300 $1,350
Family coverage $2,600 $2,600 $2,600 $2,700
Maximum contribution levels
Individual coverage $3,350 $3,350 $3,400 $3,450
Family coverage $6,650 $6,750 $6,750 $6,900
Catch up allowed for those 55 and over $1,000 $1,000 $1,000 $1,000
Maximums for HDHP out-of-pocket expenses
Individual coverage $6,450 $6,550 $6,550 $6,650
Family coverage $12,900 $13,100 $13,100 $13,300

For tax year 2018, to qualify as a QSEHRA, the total amount of payments and reimbursements cannot exceed $5,050 per employee (up from $4,950 for 2017) or $10,250 per family (up from $10,000 for 2017).

2016 2017 2018
Individual coverage $4,950 $4,950 $5,050
Family coverage $10,000 $10,050 $10,250

IRS Announces 2018 Contribution Limits

Participant limits- 401(k), 403(b) plans-                                      $18,500 (from $18,000)

Catch up for these plans, over age 50                                              $ 6,000 (no change)

SIMPLE Participant Limit                                                                 $12,500 (no change)

Annual Benefit Limit                                                                           $220,000

Defined Contribution Limit                                                                $55,000 (from $54,000)

TopHeavy Key Employee                                                                    $175,000

Highly Compensated Employee                                                          $120,000

IRA Limit                                                                                                 $5,500 (unchanged)

IRA Catchup                                                                                             $1,000



So what, exactly, did Trump eliminate on the Subsidies?

The President, in signing an executive order this past week, stopped all payments for Cost-sharing Subsidies.  Now, in a language most of you can understand:

  1.  This does not eliminate subsidies.  The Government is continuing to pay these and apparently will continue
  2. “Cost-sharing Subsidies” are only received by those on Silver plans below 250% of the Federal Poverty Level
  3. The plans are already filed and pre-approved.  Enrollees will continue to receive the same benefits as the contracts are not being changed.
  4. The Insurance company is not being paid their portion of the cost-sharing subsidies.

So in the end this affects the Insurance Carriers but not the enrolled person.  Many Insurance Carriers have already increased their premiums for 2018, based on warnings by the States that this would happen.  So in the end it may not mean much, except we all know the premiums are going up for 2018.


MEANWHILE – back in court, Attorney GEnerals in more than a dozen states, led by NY and CA, filed suit to get an injunction and prevent this from happening.  Given the recent rulings by these courts it is likely that they will win, at least temporarily.  It also seems to have stimulated Congress to discuss this, and perhaps even try and fix it.  At the center of the move is the argument that this is an expense that Congress never authorized.

New York Paid Family Leave Update

A few clarifications and updates have been released.  Also, we have a great guide on this program, just email us at and we will happily send it to you.


OUT-OF-STATE Coverage:   You are required to provide DBL/PFL coverage for any employee in NY that you employ for at least 30 days.  If the Employee lives in NY but works in another state they are not required to be covered.  Additionally those employees would not be eligible for voluntary coverage either.

COVERAGE IN OTHER STATES- If you have employees in New Jersey, Rhode Island, California, Puerto Rico or Hawaii they may be required to be on the DBL policy for that state…

June 2019
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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck