0. Health Advocacy

1. Health Advocacy Solution Close-up
Highly personalized
We do the work for the member
Helps members navigate healthcare and insurance-related issues
Experts who know the ins-and-outs of the healthcare system
Saves time and money
HIPAA compliant * *
* Based upon receipt of group’s utilization data

2. Addresses the Entire Family’s Needs
Employee
Spouse/Domestic Partner
Dependent Children
Parents and Parents-in-law

3. What is a Personal Health Advocate?
Registered Nurses with 10+ years experience in clinical care, case management, nursing education, supervision and administration
Benefits Experts with 5+ years experience in benefits administration, claims management, provider group administration
Supported by full-time Medical Directors

4. What is a Personal Health Advocate?
Trained clinical professionals – social workers, behavior change counselors, nutritionists, dieticians, dental care and pharmacy management
Single, ongoing contact person – direct dial phone number, address
Chosen for medical expertise, commitment to service excellence, communication skills and strong problem resolution approach

5. How We Help
Find the right doctors, hospitals and other healthcare providers; expedite appointments
Explain complex medical conditions; research and locate the latest treatments
Coordinate care and schedule follow-up visits; facilitate second opinions; transfer X-rays and medical records
Arrange specialized treatments and tests; answer questions about results, treatment options and prescribed medications
Clarify benefits including copays; help facilitate access to appropriate care
Provide one-on-one coaching to help close gaps in care*
Provide personalized information through Member and Client Dashboards*
Offer personal contact with Registered Nurses to support treatment decisions
Resolve insurance claims; negotiate billing
Help locate eldercare services including assisted living and adult day care; address other issues facing parents and parents-in-law
* Based upon receipt of group’s claims and utilization data

6. Special Help for Seniors
Retirees transitioning to a new health plan
How to enroll in Medicare
Clarify Medicare Parts A, B, D and supplemental plans
Inform about pre-existing conditions; dependents under 65
Locate eldercare services that fall outside traditional healthcare coverage
Assist with the transition from traditional insurance to Medicare HMO
Facilitate early care management intervention

7. Key Benefits Independent and objective Reduces grievances and appeals
Improves health outcomes
Reduces medical costs
Improves administrative efficiencies
Eases burden on HR staff
Maximizes benefits utilization
Reduces grievances and appeals
Supports consumer-driven health plans
Professional, non-adversarial approach to finding the right answers
Increases employee productivity, satisfaction and retention
Easy to install