The scene plays out every day: Employees receive health care bills or “explanation of benefits” insurance statements in the mail, but they can’t decipher the complex forms. Eventually, they call you to help sort it out.
Ever wish there was a better way?
Enter a new breed of employee-benefits advocacy firms. Through these fast-growing services, employees have 24/7 access to independent medical and insurance experts by phone and e-mail who assist with health plan issues.
Those advocacy services serve as an extension of your benefits department. Their aim: Take the pressure off HR and keep HIPAA concerns at bay.
These services handle everything from answering simple health plan questions to correcting complicated insurance coverage mistakes. They also can:
- Research and recommend medical providers, facilities and treatment options.
- Secure second opinions.
- Consult on elder care resources.
- Help educate employees about the differences among employer plans.
Former health and medical professionals, health care administrators, counselors and nurses typically staff the service’s phone lines.
Bottom line: Many advocacy services have well-proven track records, but some of their successes are hard to measure.
Still, if your company is overwhelmed with health benefit questions, is thinking about benefit changes or is injecting more consumerism, advocacy services are worth a look (see box below for more tips).
Two of the largest and most well-established providers:
- Health Advocate Inc., www.healthadvocate.com
- CareCounsel LLC, www.carecounsel.com
Also, the following groups offer certain types of employee assistance (for example, health claims assistance only) or can find a resource:
- Patient Advocate Foundation, www.patientadvocate.org
- The Alliance of Claims Assistance Professionals, www.claims.org
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