1Who is Exceedent?
Wholly-owned by Froedtert Health, Exceedent is a third party administer located in Menomonee Falls at the North Hills Health Center. As a third-party administrator (“TPA”), Exceedent processes medical claims on behalf of the Froedtert Health employee benefit plan.
2What does it mean to be self-funded?
Froedtert Health Medical Plans are self-funded. This means the dollars that pay for your healthcare come from Froedtert Health not from an insurance company. The way you use the health plans affects both the organization’s cost and employee contributions (payroll deductions).
3Who do I call if I have questions on my medical benefits?
After you receive your Froedtert Health medical ID card with your member identification, if you have any questions regarding your Medical benefits, please contact Exceedent Member Services Line at 844-532-5240 to speak with one of our Member Service Representatives from our team. You may also visit the website for more information at: my.exceedenthealth.com/froedtert/
4Who do I call regarding my questions pertaining to how my claims were paid?
To speak directly with the Member Services Representatives on specific questions on claim payments, please call 844-532-5240 or 262-532-5240.
5How do I find a Froedtert Health Preferred Network Provider?
If you have questions on network providers, you or your provider may call Exceedent at 844-532-5240. In addition, the Provider Directory is available to you online at my.exceedenthealth.com/froedtert/.. By using this site, you will be able to determine which zone you are in and to find providers in each of the networks in your area.
6Do I have access to Froedtert Health Workplace Clinics?
Yes, Froedtert Health Workplace Clinics are available to Froedtert staff. Services will also be available to staff spouses and dependents ages 16 - 25, enrolled in the Froedtert Medical Plan. The Froedtert Workplace clinics are located at Froedtert Menomonee Falls Hospital, Froedtert West Bend Hospital, Froedtert Hospital and Woodland Prime. Call 414-805-9959 to schedule at any of the 4 locations.
7Do I have access to FastCare Clinics?
Yes, FastCare Clinics are available to staff members and dependents age 18 months and older, enrolled in the Froedtert medical plan. FastCare Clinics are conveniently located in select Meijer stores and the McKinley Health Center. Visit froedtert.com/fastcare to view locations, contact information and hours of operation.
8What is a prior authorization requirement?
Prior authorization refers to the process by which a patient is pre-approved for coverage of a specific medical procedure or a select few prescription drugs. The fact that a Plan Member receives prior authorization does not guarantee that the Plan will pay for the medical care. The Plan Member must be eligible for coverage on the date the services are provided. Coverage is also subject to all provisions and exclusions described in the Plan. Your provider can submit a “pre-determination” to our office prior to services being rendered, and we will evaluate if the service is a covered expense under the Plan. Pre-determinations can be submitted to Exceedent’s Clinical Services department after December 1, 2020, by fax at: 262-532-5245.
9How do I know if I need to get a prior authorization?
If you are not sure whether you need a prior authorization for a service or prescription medication, please refer to your Summary Plan Description (SPD) services that require authorization. You may also call Exceedent’s Clinical Services Line at 844-532-5236. Please see Care Management document for a list of services that require prior authorization.
10I have a doctor appointment scheduled and I haven’t received my ID card yet. Is there anything I can do now?
Please contact Exceedent at our Member Services Line at 844-532-5240 to request a paper copy of your ID card. You may also download the Exceedent mobile app or view on the online Exceedent member portal. The portal/mobile app will also allow you to view your ID card, download the card, and print if needed. ID card(s) are mailed to your home following annual enrollment. If additional ID cards are required, please contact our Member Services Line at 844-532-5240 to request additional cards.
11Why do I receive letters asking if my dependents have other insurance?
For all dependent enrollees, we are required annually to obtain current “other insurance” information, better known as “coordination of benefits” or “COB.” If you or your dependent(s) are enrolled in medical coverage a coordination of benefits form must be completed and returned before any claims can be processed. This includes claims for newborn children. Other insurance may include, but is not limited to, coverage through a spouse’s plan, court ordered insurance coverage, coverage required in a divorce decree or paternity suit, or Medicare. If you provide incorrect or inadequate information, claims may be delayed or denied. Once received, Exceedent honors the COB form for 12-months from the date you sign the form – unless information is received that contradicts the information provided. Please see Coordination of Benefits Form.
12Why was my claim denied, asking for additional information on how my injury happened?
The Summary Plan Description requires that we investigate third party liability, better known as subrogation. In the event a medical claim has a diagnosis where there may be a third party involved, we are required to investigate the claim prior to applying payment. In addition, the Law requires that we pay or deny a claim with 30-days of receipt. It is standard practice in the industry to deny the claim with a remark code explaining additional information is required, and to follow-up with a letter requesting the information. Once the completed letter is received from you, and there is no other party involved Exceedent will reconsider the claim for payment. The letter requesting additional information will be attached to the Explanation of Benefits (“EOB”) mailed to your home or available online in the member portal.
13Can I access my account online or by mobile application?
The Exceedent Member portal is your online resource where you can: view benefit plan information, download and print ID cards, review benefit plan information, submit questions to Customer Service, and view healthcare claims and deductible balances. You may register on line at my.exceedenthealth.com/froedtert/ . We encourage you to download the Exceedent mobile app. The app is compatible for both Apple and Android users.
14Can I have someone act on my behalf, or contact Exceedent for information on my account?
If you want someone to act on your behalf in applying for benefits/appeal or act for you on an ongoing basis, you must complete an Authorized Representative Appointment Form. Be sure to select the function(s) that the representative is being authorized to do. You can select more than one representative and choose the same or different functions. The representative may be an individual or an organization. Note: This form must be completed for Exceedent to talk to you about your spouse or over-aged dependents accounts.
15What is a Summary Plan Description (SPD)?
The summary plan description is an important document that tells participants what the plan provides and how it operates. It provides information on when an employee can begin to participate in the plan and how to file a claim for benefits. The Employee Retirement Income Security Act (ERISA) requires plan administrators to give to participants and beneficiaries a free copy of the Summary Plan Description (SPD) describing their rights, benefits, and responsibilities under the plan in understandable language. The SPD includes such information as: Name and type of plan, Internal Revenue Service assigned number, the employer’s name and address, the plan administrator’s name and contact information, a statement of Health Insurance Portability and Accountability Act rights, ERISA disclosures, and guidance on how employees can file a grievance or an appeal. Exceedent does not write the Summary Plan Description (SPD).