HR People (Need your help ASAP)

If an employee is having problems with the health insurance company, how involved does the HR person need to be in order to get the problem resolved?

There have been many issues with DH's insurance and the girl in (head of?) HR continually asks him for the documents he receives in the mail (mostly medical bills.)

Is she entitled to do this? I personally don't feel comfortable providing these documents.

Are there any other alternatives?

Re: HR People (Need your help ASAP)

Depends on what the problem is.

If it doesn't involve enrollment or proof of premium payment, the company usually would not step in.

Message edited 4/6/2006 1:11:10 PM.

Re: HR People (Need your help ASAP)

Only a benefits administrator may be looking at this stuff to make sure the amount covered is correct and aligns with the plan.

If she's trying to help him with claims she is going over and above by helping him. If you are having substantial claim problems and she is helping I would be happy. That can be a nightmare.

If you feel uncomfortable-then you may have handle this yourselves.

Am I even close?

Re: HR People (Need your help ASAP)

When employees have insurance problems they can't resolve on their own, many employees go to HR/benefits with bills and EOBs in hand so that the HR/benefits people can help. The HR/benefits people have a role in choosing the insurance companies, paying their bills and they usually have other people within the insurance company they can call to escalate a really bad issue, but they need the details in order to figure out how bad the situation is and to try to help.

I suggest you get a copy of the plan's SPD and become very familiar with the appeals section so you can follow the steps to appeal a denied claim in a timely manner. If you don't follow the appeals process correctly, generally, you can't sue and your DH will be on the hook for the bills.

Re: HR People (Need your help ASAP)

Re: HR People (Need your help ASAP)

I agree with the others that HR would only be involved with medical bills if they are attempting to assist the employee with a claim.

For my company, we are self-insured but a major insurance company handles our claims (for a significantly lower fee). I know HR can push to have a claim paid because essentially its the company's money. The only person handling medical information in our company is the benefits administrator who is also our company's Privacy Officer (to be HIPPA compliant).

For alternatives, you could attempt to negotiate with the appeals process on your own. If a company violates HIPPA laws, there are SEVERE penaties (ie if the privacy made it known that someone was seeking psychiatric treatment or drug rehab) and could leave the company liabile to damages.

Re: HR People (Need your help ASAP)

Summary Plan Description -- it's a booklet that describes how the plan works. It covers things like who's eligible to be in the plan, what's covered, what's not, what to do if your claim is denied, etc.

Call HR or the insurance company and ask them to send it to you.

Re: HR People (Need your help ASAP)

Message edited 4/6/2006 1:46:16 PM.

Re: HR People (Need your help ASAP)

Thank you everyone!