Customer Service “the way it used to be.”

UGP has one customer service philosophy. To excel in responsiveness and provide the most professional and personalized service for employers.

Clients are assigned a dedicated account team that is cross-trained on the employer’s plans, so that the employer always has someone to call for immediate answers and solutions.

Our Proactive Organization

Internal Organization
As a Third Party Administrator, we are proactive. While we are free to meet for consultation at any given time, we request informal meetings each quarter, allowing discussion of secular trends in the industry, claims experience (including actual and potential shock losses), proposed changes in legislation, the interpretation of employee benefits legislation, and possible utilization abuse. At the conclusion of the meeting, we will discuss the client’s alternatives, renewal options, as well as important Human Resource and Risk Management issues.

Integrated Claims Administration
UGP provides an integrated claims system to streamline administration of multiple benefit programs in a managed care environment. Our clients enjoy enhanced data integrity and the most efficient claims operations available. We have built in the flexibility and adaptability we need to handle unique client requirements. Our commitment to service excellence creates timely and accurate claims administrative services for our clients.

Strategy and Legal Review
Upon request, our in-house counsel will work jointly with our client's corporate counsel at no additional cost for services within the scope of his profession. Our counsel will guide your company through HIPAA privacy issues and guidelines and advise you as to the appropriate course of action.

Financial Reliability Our in-house Certified Public Accountant will work jointly with our clients to address all tax law and related issues promptly and professionally at no additional cost for services within the scope of his profession. The billing support staff is trained to work with each client’s specific accounting practices and bookkeeping needs to facilitate the production of easy to read monthly statements, and to troubleshoot any problems if they occur. Registered Nurse Our in-house Registered Nurse is available in her capacity for our clients when needed. Active Participation with Clients We are prepared to train client’s staff to assist the employees in understanding their benefits program and their options, so that they make educated, informed plan decisions.

Benefit Plan Design and Review

Whether your plan is fully insured or self-funded, the design of your plan is crucial in affecting your costs. United Group Programs, Inc. provides a review of your current benefit plan to determine whether your plan has excess and unnecessary benefits that increase the cost of your plan, or limitations on benefits that negatively affect the employees and executives. Studies have found that by offering certain benefits, the employer’s cost for health insurance goes up, while those specific benefits in no way assist in the health of the employee or provide a true benefit.  Due to significant increases in the cost of health care, the implementation of creative plan design changes, now allows employers to save on health care costs for years to come.

We at UGP are pleased to offer you a cost-free analysis of your current plan in conjunction with the personalized options we offer. Our experience gives us the added confidence of steadfast relationships with insurers and reinsurers, which leads to significant savings for employers.

Our Services

Asking all the right questions
Our case management is an integrated process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs. UGP communicates with health care providers and utilizes all available resources to promote a quality yet cost-effective outcome. When approved by the client, UGP's case management program targets individual members with catastrophic diagnosis and/or high cost procedures. Our case management team "steers" members through the complex medical considerations to maximize the member’s health.

Doing it right the first time
Normally, when an insurance company or Third Party Administrator (TPA) receives a claim from an employee that consists of only a statement or “balance due”, or in some other way is incomplete, the insurance company or TPA, will return the bill to the employee with instructions that the employee obtain the itemized bill from the service provider. A confused employee often brings this problem to their supervisor, who then involves the Human Resources Department.

At UGP, we contact the health care provider directly, requesting the itemized bill by fax in order to process the claim immediately. In this way, the claims examiner proactively intercedes to insure prompt servicing of the claim. The employee is not confused and no time is taken from the workday to resolve this problem. Therefore there are no dunning notices and no phone calls. The plan runs smoothly for all involved, particularly for Human Resources.

Claims Processing
We strive for 100% accuracy.   Our audit procedures, training programs and system controls are designed to accomplish this objective.  Mandatory pre-payment audits are conducted for claims that exceed designated dollar amounts. 

Our system also reprices In-Network claims in accordance with the negotiated fee schedules and contracts. Non-Network claims are subject to the usual and customary fee data. When appropriate, charges are negotiated to obtain maximum savings for both clients and their employees.

United Group Programs, Inc. is proud that our claims turn-around time is among the fastest in the industry.  Our system permits adjudication of many claims within 24 hours.  Electronic and clean paper claims that are identified for review by the built-in controls are processed within 3 business days. 

Our quick turn-around policy results in a number of desirable effects:

• Employees perceive their health plan as a true benefit.  Thus, morale remains high.
• The need for calls by employees and providers to check claim status is greatly reduced.
• Prevention of harassment of employees by providers demanding payment is enhanced.

Benefit checks, along with detailed, easy to understand, explanations of benefit forms are issued to the covered employee and/or provider, accurately and efficiently.

Utilization Management
United Group Programs, Inc. works with Utilization Review and Case Management programs to assure quality patient care delivered in a cost-effective manner. Our integrated database and software systems allow our claims examiners, auditors and stop loss department to share information on a real-time basis.

Case Management
Approximately 80% of the health care costs come from 10% of the population. Unpredictable catastrophes and poorly controlled serious diseases are a very large source of these costs. At UGP, case management opportunities are quickly identified and aggressively pursued, by focusing on members with serious or chronic illnesses.

The nurse case manager works closely with members, family, and physicians to assess the member's health care needs and to coordinate services. Our case management team works to determine quality and cost-effective treatments of services by identification of alternative treatment plans, price negotiation, or both. 

As an essential component for effective case management, case managers maintain a positive, professional relationship with health care providers to assure the patient's health care needs are met.

The goal is to assist the member to reach his or her optimal level of wellness through high quality, cost-effective care, while reducing potential claims and minimizing the current claim's impact and overall costs.

Disease Management
People are living longer lives than ever before. This is not because there is less disease in the world. With today’s science and technology, people are able to live with otherwise deadly diseases for many years to come. For an employer, this has only been financially possible through high-cost insurance. Now, as part of the Case Management Program developed by UGP, health care costs can be decreased through proper disease management.

UGP first provides all members access to information to educate themselves about their disease, thereby providing the necessary tools for the members to manage their own conditions. By providing information about diseases such as asthma, diabetes, congestive heart failure and hepatitis C, for example, members may proactively help manage their condition and episodes in a quality manner.

Prescription Drug Management
UGP is a national leader in prescription drug management. We offer our clients the strongest and most aggressive prescription drug discounts and networks across the nation.

Claims Negotiation
UGP has designed its programs to encourage in-network care. However, out-of-network care will occur throughout the plan year. In order to save our client health care dollars on care accessed out-of-network, UGP proactively negotiates the claim. UGP has developed a proprietary database for this purpose. In situations where a member accesses care out-of-network, UGP will negotiate discounts for physician and facility claims.

In-House Benefits Call Center

Free the Human Resource Department

Making Life Easier & More Efficient

Eligibility & Enrollment Services
Employee enrollment plays a critical role in the success of any voluntary benefits program.
Participant enrollment, coverage termination, and other changes to eligibility information are made using the unique enrollment form supplied by United Group Programs, Inc. This information may also be submitted electronically or via fax.  Upon receipt, all information is reviewed for plan compliance and immediately entered into UGP's eligibility database.

UGP provides the following services:
One-on-one enrollment
Group enrollment
Enrollment by Phone
Internet Web Enrollment
Outbound Call Enrollment

Case Setup and Management
Payroll Stuffers and Communication Materials
Employee Education
Professional Enrollment Counselors
Employer Enrollment Reports

We specialize in enrollment customer service that includes communication and education services before and after enrollment. These areas are quite often overlooked. Through our proprietary and innovative system, we are able to communicate to employees exactly how a particular benefit will impact upon them and their families.

Customer Service
United Group Programs, Inc. maintains a toll-free telephone number for the convenience of clients, plan participants and health care providers. During normal business hours (9:00 am to 6:00 pm EST), the participant may speak directly with the person responsible for managing the day-to-day administrative activities of the plan.  Most inquiries are answered accurately and immediately. There is convenient voicemail or e-mail for after hours inquiries.