Bert Alicea | BenefitsPRO

Domestic violence may frequently occur behind closed doors, but the repercussions of abuse have the potential to spill over into the workplace. October is Domestic Violence Awareness Month, an opportunity to raise awareness of this important and difficult topic. For organizations who may employ either victims or perpetrators, domestic violence can impact the individuals involved as well as those around them, leading to a ripple effect of lost productivity, legal concerns, and other costs, not to mention the risk of an incident occurring at work.

Unfortunately, no business is immune to the issue of domestic violence. According to the most recent National Intimate Partner and Sexual Violence Survey, approximately a third of women and a quarter of men report being the victim of violence by a partner at some point in their lives. This means the likelihood of an employee being either a victim or perpetrator is higher than many may realize.

It is important to note that domestic violence is not limited to physical abuse. It can include any range of assaultive and coercive behaviors used by an individual to hurt, dominate or control and intimate a partner or family member, such as stalking, emotional or verbal abuse, financial control and more.

While this is a difficult subject matter to tackle within the workplace, taking a proactive approach to domestic violence can help organizations simultaneously protect their employees while minimizing their risk. Brokers and business leaders can work together to create an action plan and implement prevention and intervention strategies to address domestic violence within their workforce.

The impact on the workplace

Domestic violence impacts people of all ages, races and backgrounds, including employed adults. Although domestic violence is not always physical, tragically, 78 percent of women killed in the workplace between 2003 and 2008 were murdered by their abuser. While alarming, the effects on the workplace begin much sooner, and everyone pays the toll.

Consider that each year, domestic violence victims miss about eight million days of work, the equivalent of 32,000 full-time jobs. Because of this and other factors, the Centers for Disease Control and Prevention estimates that businesses lose $729 million each year in lost productivity related to domestic violence. Employee turnover is also a contributing factor; up to 60 percent of employees experiencing domestic violence reported losing their job as a result, either because they were fired or had to quit.

In addition to indirect costs, health care costs related to domestic violence can also add up for organizations. Domestic violence victims frequently require medical attention and support as a result of abuse, leading to combined medical and mental healthcare costs of more than $4 billion a year.

The effects of domestic violence are not limited to victims; a survey conducted by the Corporate Alliance to End Partner Violence found that at least 44 percent of those who worked with a victim of domestic violence reported feeling personally impacted, including concern for their own safety. This can also have a devastating effect on workplace morale.

Recognizing instances of domestic violence

In order to effectively support employees experiencing domestic violence, it is critical to understand some of the common signs that may indicate a problem:

  • Unexplained bruises
  • Unusually quiet/withdrawn
  • Frequent absences
  • Lack of concentration
  • Wearing concealing clothing, even in warm weather
  • Depression and/or anxiety
  • Change in performance attitude
  • Frequent breaks or appointments with friends/family
  • Receipt of harassing phone calls

If an employee demonstrates any of these red flags, intervening in a sensitive and private manner can make a difference and encourage them to seek help before the problem escalates. In order to be most effective, it is beneficial for managers and other employees to be prepared to handle this important yet personal matter. Yet surprisingly, 65 percent of respondents to a survey from the Society for Human Resource Management reported that their organization does not have a policy or program in place to prevent or address domestic violence.

It is important for organizations to realize that domestic violence does not solely happen outside working hours – a survey from the National Safe Workplace Institute found that 94 percent of corporate security directors reported domestic violence as a high security issue at their organization. Keep in mind the workplace is somewhere perpetrators know they can locate their victim. This increases risk and liability for businesses, which can also lead to additional costs, especially without a plan in place to address this issue.

A proactive approach

Many organizations may be hesitant to get involved in instances of domestic abuse or violence. Yet organizations and their partners have the potential to make a big difference by stepping in early and supporting employees, making it critical to have a comprehensive prevention and response plan ready.

  1. Assess current plans (or lack thereof). The first step is to analyze past incidents, assess the potential for issues and determine current preparedness. Taking the time to review this information will help create a plan that meets the organization’s unique needs.
  2. Develop comprehensive policy. Based on the results of the assessment, this should include internal reporting procedures, support mechanisms for victims, including enhanced security measures, and disciplinary procedures for perpetrators.
  3. Implement company-wide training. In order for the policy to be effective, it is important to raise awareness of the issue and educate both managers and employees on how to identify potential situations, follow reporting procedures and respond appropriately. This may also include what to do if an incident happens at work.

Ensure employees are in the know – Get the message out to the workforce through a variety of channels, including newsletters, posters in break rooms or restrooms, the intranet and more. This can include information about the company’s program as well as how to access available resources, such as the Employee Assistance Program (EAP), community organizations or even local law enforcement.

Benefits professionals play an important role in this process by helping organizations proactively implement the right programs to help should the need arise. Waiting until something happens might be too late. By raising awareness of this important issue and connecting businesses with EAPs and other resources, brokers, consultants and others can ensure employers are prepared to address issues related to domestic violence should they arise, reducing liability while ensuring the safety of the workforce.

Norbert “Bert” Alicea, MA, CEAP, is executive vice president of EAP+Work/Life Services at Health Advocate. Alicea is a licensed psychologist and premier trainer with over 29 years of experience in the EAP field. He has a specialization with executive coaching and management consultations in assisting with difficult workplace situations and also conducts corporate training locally and on a national level.

Keep health care costs in check

By Melissa Erickson | Healthy Living

The average American spends more than $10,000 a year on personal health care, according to the most recent estimates from the Centers for Medicare & Medicaid Services, but there are ways to keep health care expenses down.

Be healthy

While staying healthy is the most straightforward way to minimize health care expenses, that’s easier said than done. Chronic health problems cost Americans big bucks, and many of them are the result of poor health choices, said Angela Snyder, director of health policy and financing at the Georgia Health Policy Center and associate professor at Georgia State University.

Diet and nutrition matter in the prevention of chronic diseases so follow these tips: Eat healthfully and get moderate exercise, regular checkups and adequate sleep. Doing those simple things can go a long way to minimize long-term health expenditures, Snyder said.

Be a smart shopper

“Shopping around for the lowest cost is an important part of being a health care consumer,” said Dr. Raffi Terzian, senior medical director at HealthAdvocate Solutions, which works with companies and organizations to communicate insurance benefits to employees. To avoid surprise bills, find out how much procedures will cost before having them done, Terzian said.

Price-shopping can pay off big when it comes to medications. Request generics, which are required to have the same active ingredients and must work the same as their brand-name counterparts to obtain FDA approval.

“Other ways to defray costs include taking advantage of drugstore discounts and manufacturers’ coupons,” Terzian said.

Stay in-network

While how much you pay depends on your health plan, it’s always better to stay within your health insurance network. It’s also in your best interest to know what your plan covers, Terzian said.

“Certain fixed amounts are set, but out-of-pocket costs may be independent. Find out how much (a procedure or test) will cost, and have a conversation with your provider,” Terzian said.

The best time to ask for a discount on a noncovered procedure is before service is rendered.

“You have a better opportunity to negotiate on the front end,” Terzian said.

Be proactive

If your health plan offers preventative services, be sure to use them, Terzian said. For example, the Affordable Care Act requires that most health plans cover blood pressure, colorectal cancer and cholesterol screenings and flu and tetanus shots for free. If you’re taking advantage of these screenings, it’s more likely a physician will notice a serious condition earlier, which may help reduce health care costs long-term.

Use a health spending account

Health spending accounts allow a person to put money aside for future health care costs, Terzian said.

“You need to anticipate what expenses will be ahead of time and put money aside to cover them. It’s good for a whole host of medical, dental and vision expenses,” Terzian said.

For people with high-deductible health plans, a health savings account is a great way to save for medical expenses and reduce taxable income, but a user must qualify for the program, Terzian said. The government sets the limits for annual contributions, and for 2018 the limit is $3,450 for singles and $6,900 for families.

Read your bill

Mistakes happen. Protect yourself from overpaying by checking your bill. If you see something you don’t understand or think there’s an error, contact your provider and ask about the charge.

Episode 18: Managing Employee Stress

Whether stemming from work issues or their personal lives, most employees will experience stress at some point in time, and the impact can be detrimental to the organization. In this episode of Health Advocate’s Ask the Expert series, Matt Verdecchia, a senior trainer with Health Advocate’s EAP+Work/Life program, shares how employers can take steps to more effectively understand and manage employee stress at work.

By Michael Kaplan | New York Post

When Larry Nolan decided to fix his deviated septum — so askew that his nose was visibly crooked and airflow was almost nonexistent — he knew he needed to find a skilled plastic surgeon. He also knew he wouldn’t be paying retail.

The 34-year-old Californian, who co-owns the Hardcore Fitness chain of gyms, sought a price quote from the office of Dr. Robert Kotler, a highly regarded facial plastic surgeon in Beverly Hills. The initial estimate: $16,500. Nolan suspected he could negotiate a better deal.

More people than ever are haggling to reduce the cost of health care, spanning everything from annual physicals to major lifesaving surgery. And for good reason: A poll, co-conducted last year by the find-a-doctor site Amino.com, found that 55 percent of respondents had been hit with at least one medical bill they couldn’t afford to pay.

Abbie Leibowitz, founder and chief medical officer of Health Advocate Solutions, a company that advises consumers on health care and insurance needs, explains that out-of-pocket expenses are rising. Average deductibles for family plans came to $8,232 in 2017, according to eHealth Insurance. As a result, patients are devising creative ways to save cash. “If you are not attempting to negotiate, you are missing out,” Leibowitz says.

It helps to have a bargaining chip, experts tell The Post. Common points of negotiation include flexibility in scheduling, the ability to satisfy a bill quickly and — depending on your digital clout — a promise to promote the provider on social media. An expression of need can sometimes help, too.

Nolan negotiated a break by accepting a last-minute appointment when another patient canceled, agreeing to go under the knife with just five days’ notice. When the office manager asked what he’d be willing to pay for the spur-of-the-moment surgery, he said $12,000.

“They said they could do it at that price,” Nolan says — a savings of more than 25 percent.

For his part, Kotler tells The Post that he also considers markdowns for patients who sign on for multiple procedures at the same time or piggyback with another patient for what he calls “the friends and family plan.”

“If someone and her sister want work done and we can do it all in the same day, we offer a discount that can be 20 percent,” Kotler says.

Wheeling and dealing also works for dentistry. When Nolan needed crowns on his four front teeth, he scored a 50-percent-off deal in which he agreed to promote the dentist to the 150,000 Instagram followers and 5,000 Facebook friends he shares with his wife. “By posting pictures of me smiling on Instagram and tagging the dentist on Facebook, I brought the price down to around $4,000,” Nolan says. “And [the dentist] posted before-and-after pictures of me on her Facebook page.” Nolan estimates that his endorsements drove at least 20 new patients to the practice.

Ed Brodow, author of “Negotiation Boot Camp” and a negotiation consultant to Fortune 500 companies, says courage is half the battle. “It’s all about having the guts to ask,” he says.

Such was the case when he received a $2,000 quote for a dental crown. “I flinched and said, ‘That seems very high. I can’t afford that. Can you help me out?’ ” The dentist lopped 25 percent off the price.

“I knew he would rather get $1,600 from me than have me not do it or look for another dentist,” Brodow says.

Researching market rates can further empower patients in price discussions, says Derek Fitteron, CEO of Medical Cost Advocate, which aids clients in getting value out of health care. He suggests looking up average procedure costs on sites such as Medicare.gov and HealthcareBluebook.com and using those numbers as a starting point.

And don’t hesitate to negotiate if your bill doesn’t align with typical fees. “Call [the provider] and say, ‘You are charging me more than the going rate,’” Fitteron says. Doctors’ offices often acquiesce in hopes of securing payment more quickly, he notes.

In many cases, haggling after care actually gives you an edge. “That’s when you are in a position of power,” says Diane Mullins, a registered nurse with an MBA in health care management and the author of “Health Care & You: A Guide to Navigating the Health Care System and Becoming Your Own Best Advocate.” After all, the hospital can’t exactly take back your artificial hip.

Another gambit for getting a price cut after the fact: Offering to pay a smaller lump sum immediately as opposed to a larger amount in billed installments. This often results in a 15 to 20 percent discount, Fitteron says.

It can work even when your bill isn’t in the thousands. Leibowitz says that patients can haggle over co-pays, offering to pay a smaller amount on the day of their office visit. “You can offer to pay $20 on the spot rather than them billing you for $30,” he says. “The idea of getting paid right then and there is appealing [to doctor’s offices].”

As an entrepreneur himself, Nolan believes that health care is a numbers game like everything else. “Because doctors provide a medical service, people think that their prices are set in stone,” says Nolan. “But ultimately, they are also running businesses. And like all [businesspeople], they benefit from negotiating.”

Dr. Raffi Terzian | BenefitsPRO

As health care continues to grow increasingly complex, the repercussions can be especially apparent during open enrollment season. Whether organizations are changing their plans, adding new offerings or switching their approach, open enrollment can often best be described as controlled chaos for those leading the charge.

With this year’s open enrollment just around the corner for most organizations, now is the time to think ahead. Brokers and consultants can play an integral role in reducing the burden for their clients by helping them stay abreast of both ongoing and emerging trends and issues facing HR professionals. Here are nine trends and common issues to be aware of:

  1. HDHPs – The continued adoption of high-deductible and other consumer-driven health plans are driving employees to look for options that make the most of their health care dollars. Helping employees understand their options and how their choice may impact costs can help avoid issues later on.
  2. Plan changes – Between policy updates, mergers and cost shifts, the plans available to employees frequently change. This can adjust their level of coverage, premiums and cost-sharing responsibility, and provider network, making it critical that they have resources to help determine the best fit for their needs.
  3. Prescription coverage changes – As part of other plan modifications or new offerings, yearly changes to prescription coverage can also have a big impact on employees (especially those on long-term medication for chronic conditions, etc.), so it’s even more important to communicate these changes effectively to avoid issues down the road.
  4. Diverse workforce – Employees represent a span of generations, lifestyles and backgrounds, so one size plan does not fit all. It’s important that open enrollment options provide for this variety of needs.
  5. Digital options – From online platforms that help employees select plans to plan offerings like telemedicine, digital technology is playing a growing role in open enrollment as well as benefits in general.
  6. Multi-channel outreach – In addition to utilizing technology, many employers are looking to diversify their benefits communication in order to reach more employees in the ways they seek information. This can include mailers, posters, emails, small meetings, and much more.
  7. Concierge services – Due to the increasing confusion of open enrollment, more and more organizations are offering resources and services to help employees navigate the complexities. This can help reduce the burden on HR as well as ensure employees make more informed decisions.
  8. Addons – Many employees have a wide variety of additional options to consider adding during open enrollment, which may lead to confusion about what is best for each individual and their family. Effectively explaining these options, their costs and their benefits can make a big difference.
  9. Overworked HR team – As benefits continue get more complex, HR teams field an increasing number of questions and concerns from employees, especially during open enrollment.

Addressing some of these key challenges or issues in advance can help make this year’s open enrollment process smooth and successful. Open enrollment may be challenging, but working together with clients to plan ahead can enable organizations to overcome issues, leading to a more effective benefits year ahead.

Dr. Terzian is a board certified Emergency Physician with nearly 20 years of clinical and administrative experience. Before joining Health Advocate, Dr. Terzian led educational programs at a number of the country’s top teaching hospitals.

Episode 17: Addressing Opioid Misuse and Abuse in the Workplace

The inappropriate use of opiodis is a fast-growing public health issue nationwide, and the impact is also being felt in the workplace. In this episode of Health Advocate’s Ask the Expert series, we’re joined by Dr. Raffi Terzian, Health Advocate’s Senior Medical Director, to discuss strategies to address prescription drug misuse and abuse in the workplace.

Here’s how to clear up inaccurate charges and get the reimbursement you’re owed

By Nellie Huang | Kiplinger

This professional can sort through your care options or sort out medical or insurance snafus.

When Richard Crestani had eye surgery three years ago, an error in the medical billing code for the operation resulted in $18,500 in bills his insurance company refused to pay. After trying to correct the error for six months with no luck, Crestani, who lives in Boca Raton, Fla., called Kenneth Klein, a local patient advocate. Klein helps clients negotiate medical bills and resolve billing errors, and he was able to convince the hospital that the medical billing code was incorrect. In the end, the insurance company paid its share, reducing the bill by nearly $15,000. “He was very tenacious and knew just who to contact,” says Crestani.

A growing number of patient advocates like Klein can help you untangle medical bills or insurance coverage snags or assist with care-related questions, such as helping you decide whether to have heart surgery in your hometown or at a specialty hospital in another state. Patient advocates, also known as care managers or patient navigators, are often doctors or nurses, or they may be former employees of insurance companies, doctor’s offices, hospitals or other care facilities. That gives them an insider’s understanding of how the system works and how best to sort out medical snafus.

How to Find One

Patient advocates help you navigate the system, but they don’t provide medical care or make treatment decisions, says Trisha Torrey, executive director of AdvoConnection Directory, a database of independent patient advocates. Rather, they help patients make informed decisions. “Patients often don’t know what questions to ask,” says Torrey. “The advocates do.”

Many Americans already have access to these services through an employee benefits program. Health Advocate Solutions, for instance, works with 11,500 large companies and institutions worldwide, offering advocacy services to 12.5 million employees and their families. “Health care is confusing and difficult for the average person to figure out,” says Abbie Leibowitz, a founder of Health Advocate Solutions. “We help people who have any problem in health care.”

If your employer doesn’t offer a benefit like this, you’ll likely have to pay out of pocket for an independent advocate. Such professionals typically charge between $75 and $450 an hour, depending on the type of service required and your location, says Torrey. Some advocates who focus solely on billing issues charge a commission on the amount of money they save you instead of an hourly rate (or, in some instances, on top of an hourly fee). Leibowitz says the average case at his firm takes roughly two hours, spread over days or weeks.

The nonprofit Patient Advocate Foundation offers its services free. “We help patients with their entire case,” says outreach director Caitlin Donovan. Although the group deals mostly with lower-income households, anyone can call for help. “It can be hard to get through on the phone lines, but keep calling,” she says. The foundation works in tandem with many other groups, too, such as cancer and diabetes organizations.

One caveat: Patient advocates aren’t licensed, credentialed or regulated in any state. A group called the Patient Advocate Certification Board is developing certification criteria and an exam, which may launch in early 2018. In the meantime, if you’re thinking about hiring an advocate, ask your primary-care doctor for a referral, says Linda Adler, a patient advocate in San Mateo, Calif. Then interview the advocate. Ask for personal references, says Leibowitz. Find out what kinds of cases the advocate is used to handling to see whether he or she has experience with cases like yours. And if the advocate tries to sell you something, Leibowitz adds, find another candidate.

James Davis | HR Daily Advisor

At the recent #SHRM2018, I attended a session entitled “Addressing Prescription Overuse in the Workplace,” given by Norbert J. Alicea, Executive Vice President with Health Advocate’s EAP+Work/Life Services, and Raffi Terzian, the Senior Vice President of Clinical Operations and Senior Medical Director at Health Advocate. Their session addressed the astounding and alarming impact that addiction has on the workplace.

Much of the session was eye-opening and deeply concerning. Perhaps one of the most powerful things that Alicea said was that “People lose their family 5 years before they lose their job, it’s the last thing to go.” Addicts on average experienced destruction because of their addiction for at least 5 years before their addiction cost them their jobs. That’s 5 years that an addict would, at the very least, be underperforming at work and, at worse, be destructive to his or her organization.

I can’t think of a better way to characterize how important it can be to address addiction in the workplace.

The Numbers

The session covered a wealth of facts and figures. Here are a few that were presented, all about 2016:

  • 116 people died every day from opioid overdose—over 42,000 a year.
  • 2,100,000 people misused prescription opioids for the first time.
  • The economic cost due to opioid misuse and overdose was $504,000,000,000 (2015).
  • The total cost for opioid addiction and overdose treatment for enrollees in large employer plans was $2,628,000,000. In 2006, it was $278,000,000, just shy of a 10-fold increase.

While opioid deaths and new opioid addictions grow every year, and while organizations lose resources and productivity, employees who are abusing drugs continue to work. The numbers above are just a tiny slice of the true impact of opioid and prescription drug use and abuse. But how do they specifically influence the individual workplace?

Alicea and Terzian explained that, according to the National Safety Council, employees who abuse drugs are 2–5 times more likely to:

  • Take unexcused absences.
  • Be late for work.
  • Quit or be fired within 1 year of employment.
  • Be involved in workplace incidents.
  • File workers’ compensation claims.

Those costs add up very quickly with just one employee struggling with substance abuse at work and even faster if there are multiple abusers.

Addiction Is a Disease

Terzian introduced the session by saying, “We have to view opioid use through the lens of addiction. It’s not a moral failing, it’s a brain disease.” Both presenters repeated this statement many times because it’s that important. Alicea elaborated, “I’ve never run into the person who wants to be an addict in 25 years.”

The image of a hooded figure slumped in an alleyway with a needle in his or her arm does not represent the clear majority of prescription drug abusers. Most are now, or were, like everyday people, with families, lives, and careers. The difference? They have a powerful addiction, and without help, they will succumb to it.

The Red Flags of Addiction

If employers are to help, they need to be able to identify the warning signs of a drug abuser. Alicea exclaimed, “I’d bet every person in this room, in this conference, across the states, knows someone with a substance abuse problem. We all know at least one person. But if I asked that question, we won’t see a lot of hands go up. That’s the power of denial.” The presenters also mentioned that drug abusers’ fellow employees know about substance abuse problems long before the employers do. How? Because the warning signs are visible to those who know them best.

The more of the following red flags that an employee exhibits, the “greater the probability of an issue,” said Alicea.

Monday and Friday absenteeism—Users who have kept it together for the workweek might be hurting to use their drug of choice unimpeded or be spent from using over the weekend.

Absenteeism the day after payday—These habits are expensive. Payday might be the only time a user can afford to purchase his or her drugs.

General tardiness and/or absenteeism—Especially opioids can drain users of energy and make it difficult for them to come to work on time, or at all.

Poor quality of work and/or poor quantity of work—If a user can’t use at work, he or she might be experiencing the beginning of withdrawal. If he or she can use at work, the effects of the drugs have an equally distracting effect. Either way, his or her work will be affected.

Theft—The power of addiction leads many to make choices that you or I would never consider, especially if they are struggling to pay for their habit. Stealing equipment and other goods and money from work can help fund their addiction.

If drug abusers’ fellow workers know about their cohorts’ drug problems, “they are looking to see what HR or a manager is doing about this problem,” says Alicea. By not addressing the problem, what message is the company sending to its drug-abusing employees, never mind its loyal and clean employees?

Drug Abusers Know Where to Apply

Alicea said, “people who use drugs and alcohol know exactly where to go and apply for a job. They know.” What does that mean for employers that don’t drug-test new employees? It means a high probability that the workplace will experience continuous problems from drug-abusing employees. After the session, I asked Alicea and Terzian about that phenomena. They related to me a few examples of organizations that, for various reasons, wanted to avoid preemployment drug tests. “And they wonder why they constantly have problems,” said Alicea.

What Can You Do?

Once an employer realizes that employees who abuse opioids and other prescription and illegal drugs need help, it can begin to find a way to administer that help.

“A lot of companies had zero-tolerance policies. A lot of them are doing away with it, and I’m all in favor of a second chance,” said Alicea. He explained, “If you have an employee who worked for you for 10 years and they are relatively good, and they end up testing positive, and you terminate them—you don’t know if the new person has a problem, too, and you lose all of that knowledge.”

Alicea said the best way to help is to offer employees a one-time chance to get clean through a program (and prove it after the program is over) or be fired. Work, he said, represents a critical part of many people’s identity. Remember, by the time they are potentially losing their jobs, many drug abusers have already pushed their friends and family out of their lives. Their work identity might be all they have left. And that can be a powerful motivator, says Alicea. That makes them decent candidates for rehabilitation.=

Alicea said, “by threatening the job, the core values of a person, that person has a high probability of success in making the change provided that it’s monitored.” He focused heavily on the value of monitoring and reinforced it when we talked after the session. He said, “the success rate in treatment today is really, really low. But if you have someone monitoring that person for 90-120 days after the treatment, the rate is really, really high.” The reason is that they know that if they don’t follow through with aftercare, they will lose their job—their core personality—and that’s too much.

The Takeaway

This topic is incredibly complicated; the research is far from complete; and even with treatment, drug abusers have very real challenges ahead. If you deal with substance abusers at your organization—and it’s just a matter of time before you do—it behooves you to explore how you can help those people.

Episode 16: Encouraging Proper Use of the ER

The ER can be an invaluable resource when employees face a medical emergency. However, choosing the ER when other alternatives may be a better fit can have a big impact on healthcare costs for individuals and their organizations. In this episode of Health Advocate’s Ask the Expert series, we’re joined by Amy Kinsley, a nurse and Senior Personal Health Advocate, to discuss employee use of the emergency room.