About Houston Benefit Services

One size does not fit all when it comes to health plans! Most brokerages and PEO’s rely solely on leveraging their buying power with a vendor to deliver affordable benefits. Unfortunately, there is no creativity to speak of and absolutely no transparency which is critical for evaluation and competition. Besides, it simply doesn’t work. The carriers know they will end up with the business, regardless of whether a broker handles it or not. We are different! We inspect everything to guide our clients into the decision that is right for their unique business needs.

Value Proposition
We assist our clients in obtaining the highest possible value for the benefits budget. We do this by balancing a perfectly unique blend of proven risk management techniques, leveraged buying power, and creative financing. 

Most critical to our success has been our understanding of the marketplace. We understand everyone in the healthcare delivery chain: Doctors, Hospitals, Pharma, Claims payers, Governmental Agencies and Laws, Carriers and most importantly Plan Participants, especially the sick ones! 

A Totally Different Approach: A Few Examples of Our Work: That We Perform Directly:
®       Risk-free or risk/reward financing®       Your own broker or one of our partners®       Any cost sharing arrangement allowed by law

®       Rich – Mainstream – or Ultra Lean benefits

®       One plan design or many

®       Aggressive risk management that protects your assets or “conflict free that just pays all the bills”

®       Big network or little

®        Cover every conceivable medical expense or the bare minimum Spread the risk or focus on management

®       Benefit allowances instead of copaysor offer both sideby side®       Per person per year deductible or per family per month deductible®       Include or exclude brand name drugs or give employees s the option

®       Deductible Reimbursement Plans

®       Global Medical Tourism Options

®       Direct contracting with a single facility as opposed to a mainstream network

®       Wellness programs

®       Transplant Networks

®       Diagnostic, X-Ray and Lab Networks

®       Fraud, Waste and Abuse Program

®       Self Diagnosis Programs

®    Medicare Like Payments

®       Green Screen Studio Benefit Video Production®       Advanced Reporting and Research®       Stop-Loss Procurement

®       Enrollment and Form Scrubbing

®       Market Studies

®       Negotiations

®       Executive Level Customer Service

®       Plan Performance Surveys

That We Perform Indirectly:
®       BUCAH Plans (Blue, United, Cigna,Aetna, Humana)®       Plan cost modeling and scientific cost prediction®       Stop Loss Procurement

®       Legal Research, compliance and contract review

®       COBRA/FSA/HSA Administration

®       Eligibility Maintenance and Dependent Eligibility Audits

®       Consolidated Billing

®       Participant Level Customer Service

®       Claims Processing and Payment

®       Fraud Detection

®       Trust Accounting and Reconciliation

®       Tax Prep (5500’s)

®        Case/Disease/Transplant Management

List of Services We Perform

Area 1 – Account Procurement

  • Sales

o        Plan Design Consulting

§         Cost Containment Consulting

§         Class Based Design Consulting

§         Current Benefit Analysis

§         Coverage Gap Identification

§         Evaluate Financing Methods

§         Evaluate Contract Types

§         Advise on Design Recommendations

o        Sales Presentations

o        Negotiations

o        Executive Level Problem Solving

o        Client Reviews

o        Advanced System Reporting and Research

  • Underwriting

o       OpportunityProcessing and Tracking

o        Shopping Approved Stop-Loss Marketplace

o        Procurement of Stop-Loss

o        Procurement of Fully-Insured Proposals

o        Procurement of Ancillary Products

o        Preparing and Reviewing Vendor Fees and Quotes

o        Preparing Terms and Conditions

o        Ongoing Communication and Negotiation

o        Renewal Preparation

Area 2 – Implementation

  • Client Services

o        Enrollment

§         Preparation of custom enrollment materials

§         Management of On-Site Open Enrollment

§         Enrollment form scrubbing

§         Further research to complete necessary fields on Enrollment Forms

o        Ongoing HR/Benefits Management Support

§         Advanced Claim Research

§         Ex Gratia Payment Management

§         Advanced Troubleshooting

§         Attendance at Meetings

§         Being Nice in Impossible Situations

§         Some Renewal Preparations and Communications

  • Compliance

o        Ongoing research regarding laws that pertain to client Plan Documents

o        Plan Document preparation and drafting

o        Plan Document modifications integration

o        Preparing the company for legal compliance adjustments with applicable laws

o        Compliance Notice Production

o        Legal Responses to Concerns

o        RFP Responses

o        Vendor Contract Updates

o        Reporting Preparation to the government

  • Multimedia

o        Green Screen Studio Maintenance

o        Enrollment Meeting Scripting

o        Video Production

o        Video Editing

o        Video Distribution

o        Video Updates

Area 3 – Ongoing Management

  • Management

o        Maintaining Licenses with Applicable Requirements

o        Properly Staffing the Company

o        Paying Overhead

o        Paying Applicable Taxes

o        Remaining in Compliance

o        Participating in Market Studies

o        Plan Design Concept Development

o        Improving the Company

o        Vendor Negotiations

o        Contract Review

o        Setting Fees

o        Collecting Fees

o        Staff Meetings

o        Staff Reviews

o        Procurement

  • Administration

o        Enrollment Form Entry

o        ID Card Design

o        ID Card Production

o        Compliance Notice Distributions

o        Check Run Preparation

o        Check Run Distribution

o        Maintenance and Testing of System

o        Running Advanced Reports

o        Identifying and Researching System Glitches

o        Eligibility Maintenance

o        COBRA Administration

o        COBRA Entries

  • Customer Service

o        Routing Phone Calls

o        Responding to Basic Inquiries

o        Answering Customer Service Calls from Consumers in English and Spanish

o        Answering Customer Service Calls from Providers

o        Verification of Eligibility to Providers

  • Claims

o        Time and Date stamping all incoming mail

o        Claim Data Entry

o        Data Entry Auditing

o        Claim Scrubbing

o        Eligibility Determination

o        Covered Medical Expense Verification

o        Claims Auditing

o        PPO Repricing

o        Duplicate Identification

o        Coordination of Benefit Inquiries

o        Benefit Calculations

o        Dependent Status Inquiries

o        Fee Scheduling

o        Adjustment Processing

o        Collecting Invoices

o        Ex Gratia Payment Support

o        Electronic Data Interchange

o        Preparation and Distribution of EOB and EOP (for provider)

o        Check Preparation and Distribution

  • Fraud

o        Identifying Medically Impossible Situations

o        Identifying Provider Overbilling

o        Collecting Invoices for Unreasonable Implant Markups

o        Tracking Tooth Histories

o        Collection and review of additional medical records to properly pay claims

o        Reporting complaints to appropriate authorities

o        Negotiating Fair Claims Settlements

  • Information Technology

o        Custom Plan Build for each employer

o        Advanced Systematic Problem Solving

o        Vendor/System integrations

§         RX

§         EAP

§         COBRA

§         Case Management

§         PPO

§         Mental/Nervous

§         HSA

o        Website Updates

o        Employee Portal Management

o        Email filtering

o        PBX system management

o        Relationship Integrity Management

o        Recording 100% of Phone Calls

o        Data Warehouse Management

o        Programming Medically Impossible Situations

o        AdvancedQueryBuildingfor Advanced Reporting

  • Stop Loss Management

o        Contract review and Plan integration

o        Shock Claims Filing and Handling

o        Carrier Relationship Management

o        COBRA Billing

  • Trust Accounting and Reconciliation

o        Opening and Closing Accounts

o        Vendor Invoice Auditing

o        Vendor Invoice Entry

o        Preparation of Client Invoices

o        Receipt of Vendor Invoices

o        Verification of Funds in Accounts

o        Check Run Preparations

o        Account Balance Inquiries

o        Preparation of Tax Information

o        Preparation of Income Statements

o        Ongoing Check Verification

  • Case Management

o        Full Time Case Management Nurses withDiseaseStateSpecialties

o        Health Risk Assessments

o        24 Hour Ask a Nurse Medical Helpline

o        Trigger Diagnosis Identification

  • Case Management Report updates for stop-loss and executive review
  • Transplant Management