Retired Executive Tackles Health Insurance Maze

Medclaims Services Assists Clients With Their Claims

September 12, 1991|By Gil Crandall | Gil Crandall,Contributing writer

A retired Annapolis business executive who refuses to remain inactive has started a company that offers a helping hand to hundreds of county seniors facing health care insurance claims problems.

Frederick "Bud" Daley, a former manager at an electronic device manufacturingfirm, says MedClaims Services Inc. caters to those with a substantial number of health-care insurance claims. It is, he says, an area of activity that has been largely overlooked.

When the Annapolis office of the manufacturing company with whichhe was long associated was sold and moved elsewhere, Daley decided to retire in Annapolis. Recalling his unpleasant experience handling claims for his parents, as well as his own, he began to put his knowledge of data processing to work on the problem. The result was MedClaims Services Inc.

"I couldn't get a job," said Daily, 67. "Sure I'dgotten interviews, but no luck at a job.

"I did research on this and thought there really is a need. It's not just a paperwork job -- it's detective work too."

Health-care insurance, including Medicare and supplementary policies commonly called medigap policies that pick up where Medicare stops, has become increasingly complex. A growing number of people need professional assistance to obtain reimbursements for medical expenditures.

"It's unfortunate that health-care insurance is so complex. Many people get overwhelmed by the difficultyby all the forms requested. Since no two doctors bill in the same manner, the confusion becomes even greater," Daley says.

MedClaims, he adds, exists because of the complexity of our bureaucratic society.

"It's a lot like an income tax problem; it's like H & R Block for health. You have no one to go to to check up on claims," he says.

Each insurer, he explains, has its own set of rules. Retirees on Medicare usually carry a "medigap" policy. Two-income families often are covered by two or more companies. Accident plans could again involve a different company. Making a simple claim can be quite complicated, he says.

Some years ago, Daley was confronted with the task of processing multiple claims on behalf of his now-deceased parents, bothof whom had Alzheimer's disease. "The volume of paperwork involved,"he says, "proved overwhelming."

It was this frustrating experience that led him to establish his business to serve those facing similar problems.

"There wouldn't be need for this if we had a system that was easy to follow," Daley says. "People get a bill from a doctor or hospital. The bill says they still owe money and the claim may have (already) gone through. But the doctor hasn't received payment.

"People take a look at this bill and get confused and send along another check. It gets lost in the shuffle and they end up paying a bill twice."

MedClaims is prepared to act on behalf of anyone who must submit claims to any insurance carrier, including Blue Cross & Blue Shield, Medicare and companies selling medigap policies. It provides acomputerized system that tracks each bill, checks for accuracy and provides a permanent record. Each bill is scrutinized to spot errors and omissions, the two primary causes of delayed payments and rejections. The client is only required to mail each medical bill, when received, to MedClaims, which does the processing and follow-through.

"I go to their (clients) homes and make copies of their insurance policies and get them right back to them," Daley says of his procedure.

"When the bills are mailed to them, they mail them to me," he says."And I take care of the bills. It takes all the worry out for them."

Daley says that a significant number of people give up out of sheer frustration when trying to make all claims for coverage to which they are entitled.

One advantage of using MedClaims is that at year's end, the client gets a report of all expenses and receipts for income tax deduction purposes. MedClaims is also able to reconstruct a claimant's medical payments record in cases where bills or claim formsare missing. For this special service, an additional charge is made.

Daley says his business has clients all along the East Coast. He says that people trying to recover from an illness or injury ought not to have to worry with insurance claims hassles.

"I'm real enthusiastic about it. There is a real need for this service," he says.

For this reason he made an extensive study of other claims services before establishing his company.

Daley also represents PhyMed Services, a Roanoke, Va., firm that electronically processes patient claims for physicians and other medical professionals. Under new federal regulations, doctors are required to file Medicare claims for their patients, a service that adds a considerable clerical burden and expense.

"I try to keep the waiting period down for the doctors and the patients," Daley says. "I use a computer to keep track of any overduemedical bills."

Daley has decided to teach others how to work with medical claims and is helping a woman in Towson start her own MedClaims service.

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