FAQ

Have additional questions?
Reach out to us by calling (800) 236-7789 or emailing us at service@bpaco.com.

Brokers

I'm new to self-funding, can BPA help me better understand how self-funding works and why it might be a good option for my clients?

Yes - we believe in the value that self-funding brings to clients and are always eager to help our broker partners be in the best position to offer their clients solutions that will work for them over the long-term. If you're new to self-funding you can reach out directly to our CEO, Dan Cuskey, who will personally help you get the information you need. You can reach him via email at dcuskey@bpaco.com

Why choose BPA over other TPAs?

We're constantly evolving to meet the needs of our clients. Our localized expertise, in-house offerings, and excellent customer service help drive strong value resulting in high client retention.

Can BPA support me in renewal discussions with clients?

Yes - we know self-funding can be confusing, especially for first-time clients. We're here to help educate clients and co-sell with brokers as requested.

Does BPA work with brokers to deliver self-funded healthcare options to employers?

Yes- BPA feels strongly in offering design and administration of self-funded healthcare plans together with a client's broker.

How can I get in touch with BPA?

If you're new to BPA and the services we offer to clients who are self-funded or are considering self-funding, we'd love to connect to share what makes us unique among other TPAs. You can either reach out via our customer service team or directly to our CEO, Dan Cuskey, via email dcuskey@bpaco.com

Employers

How can I contact BPA?

If you have specific questions about your plan, you can always reach out to our general customer service, or a specific department. Emails are listed at the bottom of the contact us page, and general contact information included below.

‍Mail:

Benefit Plan Administrators

402 Graham Avenue

Eau Claire, WI54701

or

Benefit Plan Administrators

P.O. Box 1128

Eau Claire, WI54702-1128

Contact Customer Service:

800-236-7789 (toll free)

715-832-5535 (local)

Hours:

M-F 7:30am –4:30pm CT

How can I access information about my plan's performance?

Our healthcare portal contains key information about your plan. To access the employer portal visit https://secure.healthx.com/bpa.prov and sign in with your login information.

You can always reach out to our customer service team to discuss specific questions you have.

Who can I contact with questions about eligibility, adding a new employee, or terminating an employee from my plan?

For any questions regarding eligibility you can reach out directly to our eligibility team via email at eligibility@bpaco.com

How can I have a provider added to the PPO?

Ask your provider to contact the PPO directly, or have your provider complete the provider nomination form on the PPO website. Once the desired provider has submitted an application for membership, the PPO will screen the provider based on their credentialing criteria to become a network member. The credentialing process differs for each network.

Members

Who should I call if I have a question on my claims?

We know claims can be confusing, which is why our customer service team is on call to help you get the answers you need.

You have a right to question and/or appeal the processing of a claim. To receive an explanation of how your claim was processed, you may use the 'Online Customer Service' section of your healthcare portal, contact the BPA customer service team by phone, or email your inquiry to service@bpaco.com.

Who is eligible to add to my plan?

On most plans, an eligible dependent will be a covered person’s married spouse and each unmarried child who is not yet age 19. Some plans also allow unmarried children to be covered until ages 23 or 26. You can verify coverage information and age limits in your benefits booklet.

The term “child” is defined as:

a) A natural born child;
b) A stepchild;
c) An adopted child; or
d) A child for whom the Covered person is the legal guardian

What is pre-certification for inpatient hospital care?

Pre-certification is a part of the utilization review process; it is designed to ensure that patients receive quality care that is medically necessary and appropriate to their condition. Your managed care company must be contacted prior to a non-emergency admission. If you are admitted to the hospital on an emergency basis, you have up to 48 hours after admission to make the notification. The appropriate phone number can be found on the front of your ID card.

What is a Prescription Benefit Manager (PBM)?

More commonly known as your prescription drug vendor, a PBM contracts with independent pharmacies or a chain of pharmacies to provide prescription medicines at a discounted rate for retail and mail order prescription drug programs. Your PBM name and phone number is located on your ID card. In addition, you can find out more information about your PBM by going to the 'Benefit Information' page of the BPA healthcare portal and clicking on the link for the PBM.

What is a preferred provider, and how does using one affect my benefits?

Since changes in network participation can occur, it is important to verify that your health care provider is a current participant prior to receiving medical services. Verification can be obtained by contacting the network directly. You can also log into BPA’s healthcare portal and go to the 'Benefit Information' page. Clicking on the logo of the PPO network shown on that page will take you to the PPO’s website.

How can my provider request a copy of my eligibility and benefit information?

Providers can obtain eligibility and benefit information directly from BPA’s healthcare portal once they have signed up for access to patient information. You or your provider can also request this information by calling our customer service team.

What if I, or my dependents, have other coverage?

Most health and dental plans contain a coordination of benefits provision. This means that if one person is covered by two benefit plans, both companies share responsibility for covering the person’s health care expenses. This avoids the duplicate payment of benefits and helps hold premium costs down.

BPA periodically requests updated information regarding other coverage you and your family members have. Examples of other coverage are:

•  Medicare, either due to age or disability;
•  Group coverage through the employment of another family member;
•  Association group coverage through an organization you or a family member belong to;
•  Student health insurance covering dependent children; or
•  Coverage mandated by a divorce decree, requiring a divorced spouse to carry coverage on certain dependent children

Additional coverage information should be submitted during the enrollment period. If provided outside the enrollment period, please mail or fax to our customer service department and include:

•  The name, address, phone number and policy number of the other insurance company or plan;
•  In the case of group or employer coverage, the name of the group or employer;
•  The name and birth date of the person who is listed on the coverage as the primary member or policyholder;
•  The effective date of the coverage;
•  The type of coverage, such as medical or dental;
•  The names of the family members covered under the plan

Mail can be sent to BPA directly at the address below:

Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128

BPA's fax number is 715-838-8507. When faxing information to BPA, please retain a copy of the fax machine’s confirmation record, which shows the date, time and phone number you faxed the information from. Our customer service team will need this information if you call later to confirm receipt.

What if I have expenses for an accident or illness that may be payable by worker’s compensation insurance, car insurance, or another third party?

Your health plan may have a right to recover payment made on your medical bills if they were incurred for an injury or condition caused by another party. This right falls under the subrogation and reimbursement provision of your coverage. If we pay benefits as a result of an injury or illness that was caused by another party, we have the right on behalf of the plan to proceed against the party responsible for your injury or illness to recover the benefits the plan has paid. Under certain circumstances, the plan may also be entitled to be reimbursed for the benefits it has paid from a settlement or a judgment you receive from the party responsible for your illness or injury.

Mail can be sent to BPA directly at the address below:

Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128

BPA's fax number is 715-838-8507. When faxing information to BPA, please retain a copy of the fax machine’s confirmation record, which shows the date, time and phone number you faxed the information from. Our customer service team will need this information if you call later to confirm receipt.

If my pharmacist has a problem processing my prescription, what should I do?

First, ask your pharmacist to contact the pharmacy help desk at the number listed on the front of your ID card to find a solution to the problem. If your pharmacist will not make the call, contact the pharmacy help desk directly.

The pharmacy help desk phone number contacts your Pharmacy Benefit Manager (PBM). If your PBM indicates that the prescription is not covered, you may be required to seek pre-approval. If so, ask your doctor to send a letter of medical necessity to BPA:

Attn: Medical Review Dept., P.O. Box 1128, Eau Claire, WI 54702-1128.

I received an Explanation of Benefits form; when will my provider be paid?

The law governing self-insured employer groups requires BPA to send you a claim determination notice within 30 days of receiving your claim for benefits.

This means you may occasionally receive a claim determination notice--or 'Explanation of Benefits', as it is commonly called--before the check for benefits is released. This happens because the timing and frequency of check cycles for your employer's claims will vary depending on the funding option selected. If the benefit check has been released, the check number will be shown on the Explanation of Benefits.

Benefit checks are usually released no later than four weeks from the date the Explanation of Benefits form was mailed. If after more than four weeks you receive a “balance due” statement from your provider, call the provider to see if all benefit payments received in the office have been credited to your account. In most cases, providers have been paid, but there is a delay before it is credited to your account.

If payment has still not been received by the provider, please call our customer service team at 800-236-7789.

How long will it take to receive my ID card?

Once your enrollment form has been completed and submitted to BPA, you should receive your ID card within 7-10 business days. If you need your coverage information prior to receiving your card, you can find your ID card online via the healthcare portal. You can also call 800-236-7789 to speak with a member of our customer service team.

Do I need to file a claim?

Normally your healthcare provider will file a claim on your behalf. The appropriate mailing address is indicated on the back of your ID card, which should always be shown to your provider at the time of service. Your provider will then submit the required information to us on a standard form for processing.

If you had to pay for the service in full and need to submit the claim for processing yourself, please use the Forms section of the website and download, complete, and send us the 'Health Claim' form.

How do I add someone to my policy?

You can add a dependent to your policy during the annual enrollment period or within a number of days of a qualifying life event, as outlined in your plan booklet. You can verify your coverage information in the eligibility section of your plan booklet.

If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll the dependent for coverage provided the request for enrollment is received within the number of days specified in your plan booklet. To submit a change to your enrollment in coverage, follow the process outlined by your human resources team. As you have questions on enrollment, you may also reach out to our customer service team.

How can I verify claims paid for members on my healthcare plan?

Sign into the healthcare portal and use the 'My Claims' link. You can also contact our customer service team for assistance.

How can I obtain a copy of my ID card?

Sign into your healthcare portal and look for the link that says 'View my ID card'. You can print or download your ID card.

You can also request a new physical copy of your ID card by visiting the “Online Customer Service” page. Choose the relevant electronic form, enter your information, and submit it electronically to BPA. If you are unable to access the healthcare portal, please call BPA’s Customer Service at 800-236-7789.

How can I get a copy of my Plan Benefit Booklet?

In addition to receiving your Plan Benefit Booklet upon joining your plan, you can also view your plan benefits anytime on the BPA healthcare portal after logging in.

How can I get a copy of my Explanation of Benefits (EOB)?

Once logged into your healthcare portal, use the “My Claims” section to identify which covered person the charges were for and the date of service.  When you find the claim you are looking for, click on that Claim Number to view the EOB on your screen.  You can also click on the “Original EOB View” link to view a copy of the original EOB that was generated.

How can I correct information that BPA has on file, such as the spelling of my name, my address or date of birth?

You or your Human Resources department may call a BPA Customer Service Representative at 800-236-7789. You can also go to the “Online Customer Service” page of your healthcare portal. Choose the relevant electronic form, enter your correct information, and submit it electronically to BPA.

How can I contact BPA?

Mail:

Benefit Plan Administrators
402 Graham Avenue
Eau Claire, WI 54701
or
Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128

Contact Customer Service:

800-236-7789 (toll free)

715-832-5535 (local)

Hours:

M-F 7:30am – 4:30pm CT

Can I provide coverage for my child, a full-time student in college?

On most policies, yes. Check your benefit booklet for the age limit.

Partners

How can I obtain a copy of a patient's eligibility and benefit information?

Providers can obtain eligibility and benefit information directly from BPA’s healthcare portal once they have signed up for access to patient information. You can also request this information by calling our customer service team.

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