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February 18, 2020

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Riverstone (Fortress) Health Claims Update
Updated On: Jan 30, 2020
Hello Team: It has been awhile since our last update on the settlement of outstanding health claims under the Riverstone coverage. This email is intended to give you the latest information that we have on the situation. When we last communicated, the Independent Fiduciary had established an October 28, 2019 deadline for claims settlement. Based on our efforts, the Fiduciary granted the City additional time to settle outstanding claims. We’ve diligently worked toward that goal and as claims have been settled, many of you may have recently begun to receive Explanation of Benefits (EOB) statements in the mail from S&S Healthcare. EOB’s are not bills, but more on that later. If you have received EOB’s, there are two explanations for why they are being sent: 1. Your claim(s) with that provider was (were) settled If your claim was settled, the EOB will outline what was paid by the insurance provider and what amounts may have been applied to the copay or deductible balance, which remains the patient’s responsibility. 2. Your claim had a zero balance owed by the insurance company In this case, no further action is required on the part of the City to settle the claim, so the claim was processed and released. EOB’s for this category of claims will also outline what amounts were applied as Cigna discounts, co-pays and deductibles. Although the EOB is not a bill, you will need to contact your provider to determine if there is a balance owed by the employee. If you satisfied your portion with the provider at time of service, there should not be additional charges. As a reminder, you can send your EOB’s to the new carrier, Anthem, to receive credit toward your deductibles and out-of-pocket maximums based on what you paid to the previous insurance carrier. I have attached the form with instructions to this email. We know that this can all be confusing – HR staff is happy to look at your EOB’s and the crediting of your copayments under Riverstone to the successor plan, to help you understand if needed. Please contact Cari McDonald at cmcdonald@modestogov.com for assistance. Christina Alger, MHR, SHRM-SCP Acting Director of Human Resources City of Modesto 209-577-5490
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