"You have a great staff! Everyone is extremely friendly and answers our questions very quickly! Very happy with the service we are receiving from PBA and all of your employees!"
"My name is [withheld to protect privacy], one of your customer care coordinators, Sherry, was helping me with an old claim on an EMS charge for a broken back, and I wanted to just express how pleased I was with the service. You just don’t see it very much today. And PBA is really stepping up their game, and really knocking it out of the park, and I was really impressed with Sherry. Thank you and have a wonderful week."
Transcripts from a voicemail from an insured
County of Rock
"Too often people only share the negative and not the positive. I want to let you know that I called Tammy yesterday when an employee was in my office that had questions regarding his wife’s claims. She was wonderful and later that afternoon, I had an update (which I did not request) from her with the status of the claims. I just want to share the good, no GREAT customer service experience."
Human Resources Director
Mervis Industries, Inc.
"Being able to determine eligibility of a patient quickly is important to me. I am able to settle coverage and close the file while the patient is still in the office. Thank you PBA."
Dryer Medical Clinic
"I was just on the phone with one of your representatives. She was helping me out with several claims. I just wanted to take the time to inform you how well your staff reacts to any questions or anything we pose to them or any problems that we have with claims. Every day we deal with a lot of different providers and I just had to take the moment to stop and tell you how well your staff is. I have never in the two years of calling had dialed a rep that has been rude or abrupt with and I just thought it was time for me to let you be aware of how well your staff is and it’s a pleasure to deal with them day in and day out and to deal with refreshing people. I know they receive a lot of people that are upset and yelling, but I never have had them come across to be unshaken or unprofessional. I think you needed to know that and it’s a pleasure dealing with your staff."
"Professional Benefits Administrator has been our TPA for many years. My marketing, benefit administration, COBRA and Flexible Spending teams are just great to work with and the PBA website is very easy to use. I was very excited to see the Health and Wellness portal that is available within the PBA website. It is very comprehensive and is an excellent resource for our employees' health needs. Thanks PBA!"
Rose Frieri, SPHR
Director of Human Resources
Captive Resources, LLC
"I really appreciate all of the attention and reminders I receive from PBA regarding ACA and all the rest of this compliance maze."
HR Manager, SPHR / SHRM-CP
Mid-Wisconsin Beverage, Inc.
"Reference Based Pricing (RBP) has dramatically reduced our plan costs and allowed us to retain great benefits with low contributions from our employees."
Doreen K. Shaw
MYR Group Inc.
The Managed Care Department (MCD) Nurse was notified by PBA Customer Services of a call from a provider requesting Factor VIII, a blood-clotting injectable given to patients with a diagnosis of Hemophilia. This patient was a novice priest in training and new to the plan. Without this medication, he could bleed out from any organ or orifice and begin to deteriorate into systemic crisis to the point of death if he missed even one dose. He had been receiving Factor VIII injections daily at 1000 units per day at a cost of $1.93 per unit. PBA worked quickly with setting up Case Management, and negotiated the cost of the Factor VIII down to $1.00 per unit with one of PBA’s contracted providers. Conservatively, there was a savings to the plan of about $321,000 and the patient avoided a gap in care as well as hospitalization.
A Claims Analyst noted a significant disparity in charges for the same monthly infusion services (different sites) and forwarded the claims to our nurse for review. The nurse discovered that the patient was receiving IV Tysabri at an in-network facility located 1.5 hours from her home and occasionally at a site about 5 minutes from her home. With a change in site, it would be more convenient for the patient in terms of travel and less costly to the plan; so a proposal was made to the patient and provider to change to the site closer to her home which was within the network called Metro Infusion Center. The patient was agreeable, but the provider insisted that they would only allow the transfer if it were an approved site of their Biogen Touch Program; a program for patients with a diagnosis of Multiple Sclerosis. PBA obtained appropriate permissions from the patient, the patient’s physician, the previously treating infusion site, and the Biogen Program then had the patient’s care transitioned closer to home. The plan acquired a savings of $104,000.
An employee had been off work on FMLA for weeks. His orthopedic surgeon had attempted pre-certification for surgical multi-level fusion of his spine and was denied on appeal three times. The HR Manager requested that the employee’s medical record be reviewed by PBA before its final closure stating this gentleman was calling her daily about the denied pre-certification and complained that he was in a lot of pain. A missing component to the criteria was noted by PBA as being the main reason for the denials that were upheld. PBA coordinated with the surgeon for a peer-to-peer discussion along with submission of the missing information. The employee was able to have the requested surgery and ultimately returned to work.