This guide details how to respond to member inquiries regarding insurance claims, billing statements, and costs. Your primary function is to interpret the member's question and direct them to the appropriate party.
Agent Policy on Client-Specific Billing & Contact 🛑
CRITICAL LIMITATION: You are not authorized to discuss billing agreements, minimum enrollment periods, or the rationale for claims submission specific to the member's employer/pay organization.
| Inquiry Type | Required Agent Action |
|---|---|
| Questions on Billing Agreements, Contracts, or Fees | Direct the member to their employer or health plan for all contract and billing arrangement questions. |
| Escalation (Internal Only) | Do not attempt to resolve these complex policy questions. Forward the member's question directly to the Account Manager (AM) listed in the Quick Reference Guide. The AM will coordinate with the appropriate Subject Matter Experts (SME) or Accounting team. AM List |
Current Claim Clients Quick Reference
Use this table to quickly identify the client's Account Manager (AM) and review key billing criteria.
| Claim Client / Insurance | Account Manager | Minimum Enrollment Period? | Member Cost-Share? | Vida Sends Billing Statements? |
|---|---|---|---|---|
| Ascension/SmartHealth SmartHealth ABS | Lauren Rosenberg | Yes - 4 months | No | No |
| At Home BCBS TX | Kristin Grunzweig Kerryanne Shuler | Yes - 4 months | No | No |
| Cargill BCBS MN | Jennifer Rice | Yes - 4 months | No | No |
| Diageo UHC | Jennifer Rice | Yes - 4 months | No | No |
| Highmark | Tracy Rodriguez Samantha Trueblood | Yes - 4 months | Yes | Yes |
| Land O’ Lakes BCBS AL | Jennifer Rice | Yes - 4 months | No | No |
| Mondelez (No claims submission to insurance) | Jennifer Rice | Yes - 6 months | Yes | Yes |
| Select Health | Samantha Trueblood | No | No | No |
If you receive a question from a member and are unsure how to respond, please contact the Account Manager for that client. They will coordinate with the appropriate SMEs to ensure the member’s concern is addressed.
Billing Terms & Definitions
| Term | Definition |
|---|---|
| Claim | What a healthcare provider submits to an insurance company after providing a service to a member, in order to get paid. |
| Cost-Share | The portion of healthcare costs that a patient is responsible for paying out-of-pocket (deductibles, copayments, coinsurance). Refer to the Quick Reference Guide to see which members could have cost-share. |
| HDHP | A high-deductible health plan. This requires the member to pay a higher deductible before the plan starts to cover medical services. |
| EOB | An Explanation of Benefits. A summary from the insurance company outlining what costs were paid by the plan and specifying the member’s cost. EOBs are sent by the insurer, not Vida, and may be sent via mail or online portal. |
| Statement/Bill/Invoice | A paper statement Vida will mail to members where cost-share is applicable. This details the total amount due to Vida by the member for services provided. |
| Minimum Enrollment Period | The number of months Vida can bill for a member after they complete enrollment, regardless of whether the member utilizes or accesses Vida services. |
Member FAQ’s & Response Guidance
| Member Question/Issue | Investigation & Agent Response Guidance |
|---|---|
| "Why am I being billed by Vida?" (Received a statement or bill) |
1. Check client (Quick Reference Table). Review Member Cost-share: Claim Clients to see if a statement was sent. 2. If client does NOT send statements OR member is NOT on the statement list: It's likely an EOB. Response: Notify the member that billing arrangements are between Vida and their organization, and advise them to contact their employer or health plan for any questions or concerns. 3. If client DOES send statements AND member IS on the statement list: Response: Notify the member that they were seen by a Vida Medical Provider, and those services are subject to the member’s [insert cost-share type]. Direct them to their health plan for additional questions. |
| "Why am I being charged for labs?" | Vida does not submit claims or statements for labwork. Response: Vida Medical Providers may prescribe labs, but the member is responsible for charges based on their health plan coverage. Advise them to contact the lab company where services were provided with any questions or concerns. |
| "Why is my insurance being billed if I terminated, never used Vida, or stopped using it?" | Response: Notify the member that billing arrangements are between Vida and their organization. Advise them to contact their employer or health plan for any questions or concerns. If billing occurred when they "never used Vida," it is likely that interaction with the app initiated a billable service. |
If a Third Party Reaches out Regarding Invoice
Please use the macro Account Billing & Financial Request
"If your organization needs to request a change related to your account billing, forward an invoice, (e.g., updating payment information, changing subscription details, resolving a billing discrepancy), please do not contact the support team directly.
Instead, your organization should contact your designated representative in one of the following departments:
- Your Accounting Contact
These contacts are equipped to handle your billing inquiries directly or coordinate the necessary changes within our organization.
What Support Can Do
If you are unsure who your contact is, or if you must contact the support team, the only action we can take is to forward your request to the appropriate team (Accounting or Account Manager) on your behalf. We cannot directly make changes or provide specific resolutions to billing matters. It may take 24-72 hours during business days to receive a response."
Clients with Cost-Share Details
Use this detailed information for the two clients that may have member cost-share.
Highmark
- Cost-Share Applies If: The member is part of an HDHP AND has a prescriber visit with a Vida Medical Provider (VMP).
- Vida Sends Statement If: The member cost-share must exceed $10 per the EOB.
- Check List: Use Member Cost-share: Claim Clients to check whether Vida has sent a billing statement. (Note: This is a rare occurrence—only 12 HDHP claims submitted and no statements mailed in 2024.)
Mondelez
- Note: This process has not started yet. CS will be notified when a member reaches their 7th prescriber visit and this process begins.
- Cost-Share Applies If: The member is part of an HDHP, enrolled in a Prescribing Program (MWL or WH), has NOT met their deductible, AND exceeded 6 prescriber visits with a VMP.
- Vida Sends Statement If: The member meets the above criteria, and Vida will send the member a paper statement for a $50 copay.
- Check List: Use Member Cost-share: Claim Clients to check whether Vida has sent a billing statement.
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