July 2008


Inside this Issue:

Welcome - A Message from Chris Brown

Chris Brown, Vice President, Stop-Loss Product

It's hard to believe that the July renewal season is upon us. As you place Stop-Loss insurance for your clients, keep in mind that all Stop-Loss coverage is not the same. Like most things, what you get can vary widely. There are differences between carriers and policies that may not be obvious until your first claim occurs.

Sun Life Financial offers several unique advantages. I hope you consider placing business with us, because of the distinctions we bring to the table:

  • High-quality contract
    We believe our contract is the best in the business. It is clear, current with legislative changes and medical advancements, and covers many extras, such as managed care fees, off-label drug use, and alternative care.
  • Long-term approach
    We take a long-term approach to Stop-Loss and offer stable, pooled rates without any unnecessary jumps at renewal.
  • No new lasers at renewal
    We put it in writing, in our policy. When selected, this option also comes with our automatic Renewal Rate Increase Cap for added peace of mind.
  • Cost-containment programs
    Imagine insurance that could help lower plan costs, rather than just add to them. That's exactly what we do every day with SunResourcesSM, our innovative cost-containment program. (Read on for more information about SunResources.)

Thank you for your commitment to our mutual customers. I hope 2008 is a successful year for you and your organization, and as always, please continue to provide feedback on how we can better serve you.

Claims Spotlight

How to Speed Up Your Reimbursements

You can speed up your Stop-Loss reimbursements by submitting complete claim information up front:

What to send us:

  1. A fully completed claim form
    You can get a copy from our website. Be sure to complete every question. Also, please complete a new claim form with each submission.
  2. Copy of the covered person's enrollment record and any change in the covered person's coverage under the plan
    Why do we need this? To verify that the covered person is eligible for coverage. Our Stop-Loss policy defers to the plan's definition of a covered person, so we must confirm how a claimant became eligible and continues to be eligible. Specifically, we need: date of hire; effective date of medical coverage; certificate of creditable coverage; any changes to the employee's employment status (such as dates of FMLA, STD, LTD, and COBRA, including proof of COBRA payments); and if the claimant is a dependent: documentation of other insurance/coordination of benefits; and full-time student status.
  3. Copies of all bills over $25,000 and invoices for expenses incurred
  4. Proof of payment of any expenses submitted for reimbursement or a claims paid detailed report
    If you submit a claims paid detailed report, it must include: dates of services; provider name and TIN; amount billed; discount amount; eligible amount; amount and date paid; reimbursement amount requested; previously paid amount; ICD 9 codes and CPT codes.
  5. Other information as needed
    Depending on the specifics of the claim, we may request other information, such as: accident, subrogation, or medical reports; transplant protocols and consent forms; itemized hospital bills; large case management reports; and re-pricing and audit sheets. If we need it, we will tell you promptly.

Sending in complete information up front will mean faster reimbursements for your clients. We process Specific claims in an average of 15 days, but if information is missing, we "stop the clock" and resume it once the information is received.

Have Questions?

We're here to help. Call us:

Liz Dodson
Senior Claims Manager
1-800-432-1102, ext. 2130

Mari Oakley
Claims Manager, Wellesley
1-800-432-1102, ext. 2160

Lisa Demczuk
Claims Manager, Windsor
1-800-451-2513, ext. 1493

When to send it:

You should provide us with proof of claim as soon as reasonably possible after the Specific deductible has been reached, and certainly no later than 12 months after the end of the applicable Specific claims basis.

Where to send it:

You can submit claims via:

Email: stop-loss.claims@sunlife.com

Fax: (781) 304-5305

Mail:
Sun Life Financial
Stop-Loss Claims, SC 3219
One Sun Life Executive Park
Wellesley Hills, MA 02481

Let SunResourcesSM Help Manage Claim Costs

Managing the minority of plan members that account for a majority of the plan's costs can be a TPA's biggest challenge. Let Sun Life Financial be your partner with SunResources, our cost-containment program. Every day, we help our customers and their TPAs lower claim costs. In some cases, we have even helped customers save more money on a single claim than they spent on their annual Stop-Loss premium!

As one of the largest Stop-Loss providers, we're able to negotiate discounts with leading vendors across the country. And our staff of clinical experts can help identify opportunities for savings and provide assistance that can make a significant difference for:

  • Transplants
  • Neonatal care
  • High-risk pregnancy management
  • Utilization review and case management
  • Home health care
  • Durable medical equipment
  • IV home infusion drugs
  • Specialty outpatient care
  • Out-of-network and repricing services
  • Kidney dialysis
  • Congenital heart disease
  • Fraud detection and investigation

For more information about these services, please contact:
Paul Gatanti - paul.gatanti@sunlife.com, 1-800-432-1102, ext. 3920
Linda McCarthy, R.N. - linda.mccarthy@sunlife.com, 1-800-432-1102, ext. 1135

Savings Spotlight

Lower Your Kidney Dialysis Costs

Left unmanaged, kidney dialysis costs can easily escalate out of control, creating an expensive problem for employers.

Sun Life Financial offers a solution — access to deep discounts at a national Centers of Excellence network for kidney dialysis, along with experienced renal case management. This combination of deep discounts and case management can produce positive outcomes with significant savings.

Available through United Resource Networks (URN), this program provides patients with access to some of the nation's leading dialysis centers. URN's program connects patients with the best and most appropriate care, while reducing inpatient admissions and out-of-network costs. Nurse consultants are available to help patients understand their kidney disease and related health issues. They also provide clinical oversight and intervention that can help reduce overall treatment costs.

For more information about lowering your kidney dialysis costs, contact:
Paul Gatanti - paul.gatanti@sunlife.com, 1-800-432-1102, ext. 3920
Linda McCarthy, R.N. - linda.mccarthy@sunlife.com, 1-800-432-1102, ext. 1135

Contact Us

Want to speak to us? Feel free to send any general questions or feedback to: tpa.insight@sunlife.com.

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