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Hold Harmless Program

Hold Harmless Program

The Hold Harmless Program is part of the Funds’ Benefit Plans. It protects beneficiaries from having to pay balances on medical claims that were denied because of the Funds’ payment level or because the service was not medically necessary. Beneficiaries are responsible for payment of copayments and non-covered services.

Contact the Funds’ Call Center at 1-800-291-1425, as soon as you receive a balance bill, collection notice, credit denial or legal action. The Funds will need to review all the information that was sent to you. The Funds will review the balance and let you know if the denied amount is protected by the Hold Harmless Program or if you need to pay for a copayment or a charge for a non-covered service.

The following information will explain the different types of notices you may receive regarding a balance, and how the Funds and the Hold Harmless program will help you.


 

Balance Bills

This type of notice is usually from the provider and shows the current balance amount. Most providers send this out automatically and it may be sent to you before the Funds pays the claim.

  • Do not pay a provider for more than your office copayment or inpatient hospital copayment.
  • Contact the Funds’ Call Center for assistance with a balance bill.
  • The Funds will inform you of the claim payment status or if there are any copayments or non-covered charges in the balance that you need to pay.

 


 

Collection Notices

This type of notice may come from a provider, a collection agency or a law office. The notice will inform you of a balance that is owed and may tell you that the amount must be paid within a certain time period.

  • Contact the Funds’ Call Center immediately so that the Funds can review the balance.
  • If the balance was denied because of the Funds payment level or because the service was not medically necessary, you will need to sign and return a letter to the Funds authorizing the Funds to represent you regarding the collection issue.
  • The Funds will send a letter along with the signed authorization form to the collection agency stating that the Funds is formally disputing the collection account and requests that the collector contact the Funds directly regarding the collection balance.
  • The Funds will inform you if there are any copayments or non-covered charges in the balance that you need to pay.

 


 

Credit Report Problems

This type of notice may be sent to you if you applied for a loan or any other type of credit and the application was denied or you may find a medical account on a copy of a credit report that you request.

  • Contact the Funds’ Call Center immediately if there are medical balances listed on your credit report so that the Funds can review the claims.
  • The Funds will need you to fax or send a copy of the credit report to the Funds. You should circle the accounts that you want the Funds to review.
  • If the balance was denied because of the Funds’ payment level or because the service was not medically necessary, the Funds will inform the lender or creditor that the balance is in dispute.
  • The Funds will request that the account in dispute be excluded from consideration in the credit or loan application.
  • The Funds will work with the provider if the balance involves an unpaid claim.
  • It is important for you to know that although the Funds will try to help you with a credit report problem, the Funds cannot guarantee that a credit report entry will be removed or that a loan or credit application will be approved.

 


 

Legal Action

It is very important that you contact the Funds’ Call Center immediately if you receive any legal action involving a medical claim. This type of notice may be in the form of a Warrant, Summons, Proof of Claim, Notice to Appear, Estate lien, tax offset or other titles. It may be served on you in person or by mail and will identify the name of a court, the attorney’s name or provider’s name that filed the case and will list you and/or your spouse’s name as the Defendant. It may tell you that a hearing date has been set, or tell you what other action you need to take before a certain date.

  • The Funds must receive notices of legal actions promptly and before any date in which a response or a court appearance is required.
  • You will need to fax or send all pages of the legal action you received to the Funds.
  • The Funds will review the balance. If the balance was denied because of the Funds’ fee level or because the service was not medically necessary, the Funds will provide a legal defense for you and handle the case on your behalf until it is resolved.
  • You will be required to sign and return a consent form authorizing the Funds to act on your behalf and to retain an attorney if needed to defend the case.
  • You will not be responsible for any legal or other expenses involved to defend the case.
  • The Funds will work with the provider if the balance involves an unpaid claim.
  • You will be responsible for any charges that are identified as copayments or non-covered charges.
  • It is important for you to understand that the Funds cannot prevent legal action from appearing on your credit report.

Frequently Asked Questions

No, you should not pay a provider for more than your normal copayment. Contact the Call Center if you would like the names of doctors in your area that accept the Funds’ payment levels.

You do not need to pay any denied amount except if the denial states the services are not covered by the Funds. You may also need to pay a copayment that was not paid at the visit.

The Funds and its Hold Harmless program cannot protect you or obtain a refund for you if you choose to pay the balance on a medical claim. Any balance is subject to collection, credit report referral and/or legal action. It is your decision whether you want to pay a balance or whether you want the Funds’ Hold Harmless program to protect you from paying the balance that involves fee level or medical necessity denials. The Funds cannot prevent balances from appearing on a credit report and cannot guarantee that an account will be removed from a credit report once the claim is paid, or a legal action is resolved.

The Funds is not able to prevent a balance from being referred to a credit bureau or on a credit report. Should you have a balance from a medical bill added to your credit report, you may contact the Call Center to get assistance in disputing the balance.

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