Upload
others
View
5
Download
0
Embed Size (px)
Citation preview
Allianz Global Assistance
Simple. Safe. Smart.
Green Shield – University of Windsor Information Session
Presented by Allianz Global Assistance
January 14, 2014
2 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12
Who We Are
1
3
400,000 Service providers
worldwide
40 languages
Group offices
in 34
countries
Helping people,
anytime,
anywhere
mission Our
4
Our Values
5
A Worldwide Presence Designed to Help
Group offices
Branches
Commercial activity
Americas
Countries with
group offices
• Brazil
• Canada
• Mexico
• USA
Countries with
commercial activity
• Argentina
• Chile
• Columbia
Asia Pacific
Countries with
group offices
• Australia
• China
• India
• Japan
• Malaysia
• New Zealand
• Singapore
• Thailand
Countries with
commercial activity
• Indonesia
• Philippines
• South Korea
• Taiwan
• Vietnam
Europe Middle East Africa Countries with group offices
• Austria
• Belgium
• Czech Rep.
• Egypt
• France
• Germany
• Greece
• Ireland
• Italy
• Saudi Arabia
• Lebanon
Countries with commercial activity
• Bahrain
• Bosnia/Herzegovina
• Bulgaria
• Croatia
• Denmark
• Estonia
• Finland
• Hungary
• Kuwait
• Latvia
• Mauritius
• Poland
• Portugal
• Reunion Island
• Russia
• Spain
• Switzerland
• The Netherlands
• Turkey
• UAE
• UK
• Lithuanua
• Luxembourg
• Moldova
• Morocco
• Norway
• Oman
• Qatar
• Romania
• Serbia
• Slovak Rep.
• Slovenia
• Sweden
• Ukraine
• Uzbekistan
6
Our Canadian Operations
• Established in 1988
• Head office in Kitchener, ON
• 24/7/365 emergency assistance
• 280+ Employees
• Over 8 million Canadians covered
• Trusted by top Canadian travel and
financial services brands
• Employee engagement score from
Global Employee Survey: 88%
• Average Net Promoter Score of
over 78%
6
7 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12 7 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12
23 RN Case
Managers 60 call centre
agents
606,348 calls
received
68,181 assistance cases
opened
251,573 claims
processed
11 languages
In-House Support: Key Stats in 2012
7
8
Selected Key Partners
9
• ICMI’s 2012 Call Centre of the
Year Award
• ICMI 2012 Silver Award for Quality
• IQPC’s Best Contact Center
Learning, Development &
Recognition Program (2012)
• 2011 Finalist in the Insurance
Canada Technology Awards
(ICTA) for our Online Claims
Submission Tool
Award-Winning Service
10 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12 10
What We Do
2
11
• Pre-Trip Assistance
• Emergency Message Centre
• Emergency Legal Referrals
• Emergency Translation Services
• Referrals
• Cashless Service
• Medical Case Management
• Medical Transportation
• Cost Containment
• Claims Payment
• GHIP Recovery
• Coordination of Benefits
Services Provided to Green
Shield Members
12
• 25 years experience servicing Canadian travellers
• 8 million+ covered by assistance services
• Experienced in-house nursing team of 23 Registered Nurses
• Average over 10 years critical care experience per RN
• Exclusive partnership with five Emergency Physicians
Emergency Assistance Specialists
Areas of nursing expertise include:
• Emergency medicine
• Pediatrics
• Coronary and medical/surgical intensive care
• Utilization review
• Rehabilitation
• Oncology
13
• Local presence around the world allows us to:
• Expedite delivery of medical information
• Confirm legitimacy of facility and appropriateness of care
• Identify cultural differences in medical care
• Enable billing arrangements from providers who otherwise would require
patient to pay prior to leaving hospital
Our International Reach
International network covering all countries…
• Selection, management and control of service providers by
dedicated international team
• 118 administrative and medical correspondents worldwide
• 400,000 service providers
14
• Market leading quality-verification initiative
• Evaluations performed on-site by Allianz medical staff
• Results available to Canadian staff via intranet
• Regular provider re-evaluations
Proprietary Provider Rating Tool
1,716 hospitals…
542 cities…
137 countries…
15 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12
Screen Capture: Hospital Search in Cuba
16
Screen Capture: A Tale of Two Hospitals
Hospital A Hospital B
Rating: 1 out of 5 Stethoscopes Rating: 4 out of 5 Stethoscopes
Based on the information available, Allianz Global Assistance RNs are able to select the hospital with the appropriate facilities and standards of care.
17 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12 17
Case Management
• 24/7 in-house RN support
• Real time monitoring and approval
of emergent medical treatment
• Advise patient / provider up front
regarding terms and conditions
• Pre-approval of all invasive
procedures
• Review patient medical history
• Liaise with physician, patient and
family
18
Medical Transport
Providers are screened through RFP
process:
• Site visits to validate RFP submission
• Inspected for maintenance documentation
• Review protocols for medical transports
• Selection can be made based on
availability and price
Working relationship with medical desks at
commercial airlines
Advanced cardiac life support from certified
physicians, paramedics and nurses for
transport
19
Claims Management
• $11.2M USD in averted costs (Case
Management)
• 80% adjudicated within 10 days
• 99% financial accuracy rate
• 98% procedural accuracy rate
• Require original itemized bills for GHIP
submissions
• Claims reviewed to ensure only pre-
approved treatments are paid
• System Check for duplicate and repeat
cases
• Bills over a specific dollar limit are
reviewed by RNs
19
20
Government Health Insurance Plan (GHIP)
• Money recovered from member’s provincial insurance (e.g. OHIP)
Coordination of Benefits (COB)
• Payments made up front by Allianz
• Any money owed by other insurance (i.e. spouse’s coverage or purchased coverage for example) coordinated after the fact as per CHLIA guidelines
Subrogation
• Pursue if possibility of third party’s liability
Recoveries
21
3 Points of Interest
22
• Continue to see delays in some
provinces when attempting to find
receiving beds.
• Saw more willingness from Canadian
physicians to accept patients prior to their
surgery being done in the USA.
• Some Medical Facilities still requesting
deposits, a trend that the travel insurance
industry is working to combat.
• Increased presence of Collection
Agencies and/or 3rd Party Audit
companies acting on behalf of medical
providers
Industry Trends
22
23
It is important to call when a medical
emergency arises, rather than just paying
for the treatment and submitting the claims.
• Allianz can direct member to
appropriate level of care with preferred
provider
• Allianz can arrange billing with medical
provider
• Allianz will monitor care to approve any
subsequent required treatment, tests,
etc.
• If member does not contact Allianz for
assistance within 48 hrs, the member
may be subject to a managed care
penalty
Points of Interest
24
GHIP covers Canadians while travelling.
• The Government will cover a minor
portion of what is billed
• The US healthcare operates as a
business
• Transportation, Prescriptions, Trip
Interruption or Delay, Equipment, etc.
are not reimbursed by GHIP
• Not all provinces have interprovincial
agreements and patients may be asked
to pay for services up front
• Transportation is not covered by GHIP
• Only covered up to certain amounts and
treatments
Points of Interest
25
Adequate health care is available in any travel
destination.
• This is true, for the most part, in the US
and Canada.
• This is not true in many foreign
countries.
• We have put measures in place and
have a worldwide presence to assist
members in getting to the most
appropriate level of care.
Points of Interest
26
Allianz will immediately move the patient to
a medical provider of the patient’s choice.
• Medical appropriateness is the first priority of
Allianz
• Evacuation is arranged based on medical
necessity, not appearance of facility and
preference of patient/family.
• Cultural, geographical and economical
differences impact the amenities at a medical
provider, however, medical capability is
highest priority.
• A patient is required to be medically stable to
travel before Allianz arranges repatriation for
ongoing care.
• If member requires ongoing care as an
inpatient, a receiving bed must be available in
Canada (cannot drop in ER)
Points of Interest
27
Does travel insurance guarantee that no
expenses will be incurred if you get sick
while travelling?
• In most cases, Allianz can arrange for
cashless service
• Allianz can engage local business units
to assist with billing challenges
• It is the right of medical provider to
request payment/deposit up front from
the patient
• Certain services are not available
cashless (PX, equipment, etc)
Points of Interest
28
• All expenses will be covered in the event of
a medical emergency while travelling.
Reimbursement of eligible benefits for emergency services will be
made only if the services were required as a result of emergency
illness or injuries which occurred while you were vacationing or
travelling for other than health reasons.
Benefits will be eligible only if existing or pre-diagnosed conditions
are completely stable and you are fit to travel (in the opinion of
Green Shield Canada and/or our Assistance Medical Team) at the
time of departure from your province of residence.
• If medical care is no longer emergent,
continued treatment will not be covered.
• Policy benefits differ. It is important to
be aware of what benefits are covered.
• Some benefits may fall under extended
health care rather than emergency
travel assistance.
Points of Interest
29
Travelling for the purpose of treatment.
• The policy covers pre-approved referral
treatment, should all options be
exhausted
• Approved referral benefits would cover
any charges above what the GHIP plan
would cover, as long as they are eligible
benefits under the plan
• Transfers from a Canadian facility to a
US facility are not considered eligible
benefits under this plan, as those
services should be covered by GHIP
• Technical benefits would not be eligible
under this circumstance
Point of Interest
30
“Your staff & service were absolutely superb
in meeting every need of my unforeseen
medical emergency. Many thanks.”
“If everybody was treated the way you treated
me then the world would be perfect”
“The quality of the services Allianz Global
Assistance has provided to my wife and me
over the years has been absolutely superb.
The associates have been unfailingly
understanding, patient, and professional.
We are happiest when we don’t need your
services, and extremely grateful when we do
because we know that what Allianz Global
Assistance will provide will be first class.”
Customer Feedback
31
“The receptionist at the clinic I had to go to was
very impressed with Allianz Global
Assistance. When I told her that Allianz Global
Assistance would look after my case, she was
really happy as she had just dealt with you the
week before. They are so good to work with”
was her comment”
“It felt like I was dealing with family”
“Fantastic service provided to a frantic mother
needing quick help for her newborn, every call
was answered by knowledgeable staff willing to
answer all my questions. Thank you for an
outstanding experience.”
Customer Feedback
32
During this
presentation,
we assisted more
than 5,251 people.
Thank you!
33
4 Questions?