For Providers: 2020 Health Benefits Frequently Asked Questions



Every year, Argus reviews its current health policies and makes revisions needed to keep up with Bermuda’s rapidly changing healthcare system. This year’s renewals are effective as of June 1, 2020 and this guide will help to answer your questions regarding this process.


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Provider
Frequently Asked Questions
2020 Health Benefits

 

 1. How is Argus supporting providers during the COVID-19 pandemic?

During this unprecedented time, Argus is here to help providers adapt to these new challenges by offering flexible and meaningful solutions. To learn more click here.

To keep up to date on Argus policies, coverage information, and to find answers to frequently asked questions, visit our dedicated COVID-19 webpage at www.argus.bm/coronavirus.

2. What are the 2020 benefit enhancements to Argus health plans?

Every year we review benefits to ensure that they meet the unique healthcare needs of our members. This year we have introduced minimal, but meaningful, enhancements.* 

  • Mental Health and Substance Abuse Treatments – We have removed the limits on overseas Mental Health and Substance Abuse Treatment. These treatments will now be considered like any other physical condition requiring treatment overseas at an Argus preferred network provider.

  • Specialty and High Cost Prescription Drugs - We have seen an increase in the use of biologics and other breakthrough specialty medicines. Specialty drugs are significantly more expensive than traditional prescription drugs but can ultimately decrease the debilitating effects of certain diseases and improve the quality of life for our members. To provide greater and affordable access to these drugs, they will now be covered at 100% but only if pre-certified and approved by Argus OTH; otherwise at 50%. Prior to prescribing, please submit requests for medical review and pre-authorisation to insurance@argus.bm. 

    * Depending on each member’s healthcare plan

3. Who should I contact if an Argus member requires medical assistance overseas?

Argus, in partnership with our overseas care management company, One Team Health (OTH), provides seamless overseas healthcare management while helping to reduce and control costs. To ensure that our members receive the maximum reimbursement under their insurance plans, please contact OTH for pre-approval. Please refer to the Argus website for the most up to date facility listings. OTH administrators are also available to assist you in locating specialists within our network for overseas care. To contact an OTH representative email overseascare@argus.bm or call 1-905-532-2954

4. Can I continue to use BHeC ICD 9 and ICD 10 Listings?

The Bermuda Health Council has announced that effective June 1st, 2020, ICD 10 codes are required for claims submission. ICD 9 codes will no longer be accepted.

5. Can I continue to submit hardcopy claims?

Hardcopy paper claims will not be accepted until further notice. Claims can be submitted electronically via the Provider Portal, either via our Online Claims submission feature or scanned into PDF format and uploaded. To assist us in paying claims quickly and accurately, please ensure that claim forms are (i) completed in full, (ii) contain current policy and certificate numbers, and (iii) include the total billed amount.

6. What tools are available to help Argus members better manage their healthcare?

Supporting the physical, emotional and financial wellbeing of our members is a top priority. We encourage our members to take full advantage of the broad range of Thrive. tools and resources, which are available at no additional cost.

7. What are the benefits of using the Argus Provider Portal?

The Provider Portal offers easy access to tools and functionality that help you support our members and administer your Argus account:

  • Access benefits information 24/7
  • Submit claims online and receive payment within five to seven working days. Hardcopy claims submissions may experience longer processing times
  • View member accumulators/balances per benefit
  • View and print Explanation of Payments (EOP)

8. Can I receive my Argus payments via electronic funds transfer (‘EFT’)?

Yes. EFT allows you to receive your Argus payments directly into your bank account. To set up, please contact our Customer Service Centre at 298-0888 or email insurance@argus.bm.

Once set up, funds will be transferred into your account typically on Tuesday or Wednesday and a PDF version of the associated Explanation of Payment (EOP) will be emailed to the specified email address.

If you have any further questions, please contact the Argus Customer Service Centre at 298-0888 or insurance@argus.bm