2023 Frequently Asked Questions
What are the 2023 benefit enhancements to Argus health plans?
Every year, we review our benefits to ensure that they meet the unique healthcare needs of our members.
Effective 1 June 2023, we have introduced meaningful changes to our benefit plans, noted below:
- Non-solid Organ Transplant Network – to provide world-class care while reducing costs for Bone Marrow, Stem Cell, and CAR-T therapies. The network features a new partnership with the Royal Marsden Hospital in the UK.
- Allergy Testing – increased from $600 lifetime to $900 every five (5) years.
- Physical Medicine and Supplementary Therapies: now inclusive of Complimentary & Alternative Therapies (e.g., massage, chiropractic, osteopathy, acupuncture, and naturopathy) increased the maximum from $75 to $85 per visit and a combined maximum of $3,600 per policy year.
- Individual Visit – increased the maximum from $75 to $85
- Group Session – increased the maximum from $35 to $40
- Chiropody/Podiatry – increased the maximum from $75 to $85 per visit.
- Specialist Consultations at Island Health Services and Family Practice Group - 100% of billed charges covered for Endocrinology and Internal Medicine consultations.
- Student Mental Health Hotline - available to students studying overseas.
- Neuropsychological Testing (NPT) - one test every two policy years with a maximum benefit of $5,000. The implementation of NPT to evaluate cognitive and behavioral abilities is available on the island. Psychologists utilize a set of standardized tests that can be completed in several hours. Argus is pleased to provide access to testing through our pre-certification process, as noted below:
Pre-certification NPT Guidelines for Providers
- The primary care physician or pediatrician refers their Argus member to the testing provider/psychologist. The referral must include the provisional diagnosis and symptoms.
- The psychologist’s visit/interview must be complete at the time of the pre-certification request. If NPT is indicated after the psychologist’s visit, complete the NPT Request Form and submit it to email@example.com, attention ‘Provider Relations’.
- The psychologists as the testing provider must submit the NPT Request along with the primary physician’s referral and any supporting documentation.
Upon review, Argus will reply in 3 to 5 business days. The response will be given in writing to the Psychologist to conduct testing.
Depending on your patient’s healthcare plan
Who should I contact if an Argus member requires medical assistance overseas?
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 firstname.lastname@example.org or call 1-905-532-2954.
How do I submit claims?
Claims can be submitted electronically and securely via the Provider Portal, either via our Online Claims submission feature or scanned into PDF format and uploaded. This ensures the fastest turnaround time and best traceability for claims adjudication and payment.
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.
Claims can also be submitted through Electronic Data Interchange (EDI) if your Practice Management software has the capability. Integration steps are required to enable this option. Please contact our Provider Relations Manager, Karima Smith, RN at email@example.com for next steps and to discuss timelines if this option is of interest.
What is Thrive. Case Management and how can it help me and my patients?
Thrive Case Management is a free, voluntary service available to all Argus-insured patients. The service is for those with complex health conditions and need extra help understanding their condition and benefits. We also connect patients to local care providers, community services, and other resources, as needed.
A Thrive Case Manager, a registered nurse, will privately and confidentially work with your patient and their support persons to help them take a more active role in managing their health. We believe this enhances the managing physician’s clinical engagement with the patient.
Patients who benefit most from one-on-one assistance include those who:
- Are being discharged from an inpatient stay or have received care overseas
- Have at least one of the care needs below:
- Have one or more chronic health conditions including, but not limited to, heart disease, diabetes, hypertension, inflammatory bowel disease, degenerative musculoskeletal disorders, renal disease, etc.
- Have undergone an organ/tissue transplant
- Have complex medication regimes (high cost or specialty drugs)
- Have durable medical equipment needs
- Have a high-risk pregnancy
If you have patients who would benefit from our Thrive Case Management Programme, please contact us at 298-0888 or email us at firstname.lastname@example.org. To begin the referral process, complete this form and email it to email@example.com.
What are the benefits of using the Argus Provider Portal?
The Provider Portal offers easy, secure, access to tools and functionality that help you support our members and administer your Argus account:
- Access benefit information 24/7
- Submit claims online and receive payment within five to seven working days. May experience longer processing times with hardcopy claims submissions
- View member accumulators/balances per benefit
- View and print Explanation of Payments (EOP)
Can I receive my Argus payments via electronic funds transfer (‘EFT’)?
Yes. All reimbursements are paid via EFT. Click here for EFT sign up. Once set up, funds will be transferred into your account typically on a Tuesday or Wednesday and a PDF version of the associated Explanation of Payment (EOP) will be emailed to the specified email address.
Note: Health claim reimbursements will no longer be paid via hardcopy cheques. If you have questions, please contact the Argus Customer Service Centre at 298-0888 or firstname.lastname@example.org.