Leading Edge Administrators
The Pathfinder Services health plans will partner with Leading Edge Administrators, a third-party claims administrator, utilizing the Anthem National PPO network for physician and facility services. Leading Edge will be a point of contact for understanding your Anthem plan. You will be able to register for your Member Portal, where you can view your Summary Plan Descriptions, track deductible status, view and download your Explanation of Benefits, request an ID card, and more.
When you have a medical service, the provider submits that claim to your insurance company. Once your claim is processed through that insurance, your insurance carrier, Leading Edge Administrators will provide an explanation of benefits or EOB, that is sent to you or accessible through your member portal. It’s very important that you either open your mail or download a copy of your EOB from the member portal.
It is even more important that you review the EOB to see what you owe, especially in comparison to any bills you’ve received from a doctor or facility for a claim. It is not uncommon for a bill from a hospital or doctor’s office to show up before you get a copy of the EOB. In some cases, a bill may be generated before they’ve even ran your insurance, so it’s even more critical that you wait to pay any bills until you have received your EOB from Leading Edge.
An EOB will show you the service date, billed charge, what the network discount was, any copays you may owe or may have paid, how much insurance will pay, and ultimately how much you owe the provider or facility. Additionally, if a claim is denied for some reason, it will give you a reason code and often a brief description. It’s important to pay attention to this information and when unsure what the codes or descriptions mean, contact the Concierge Care Team at Leading Edge Administrators for assistance on your claim.
You should never pay more to a provider or facility than what is listed on the explanation of benefits.
