- +Claims Denial
Sean has multiple sclerosis and shortness of breath, and his doctor recommended he get an MRI of the brain stem, neck and thoracic spine.
Even though it was ordered by his doctor, his insurance company continued to deny the service.
Sean called Health Advocate. His Personal Health Advocate:
- Conducted a clinical intake, reviewing his medical history and diagnosis
- Contacted his insurance company, who said additional detail was needed from the provider
- Reached out to his doctor to inform him about the clinical information that was needed
- Got the MRI approved and made Sean an appointment at the recommended MRI facility
- Sean was amazed how easy it was for Health Advocate to handle the situation so he could get the care he needed
- +Hospital Bill Appeal
After the birth of her baby, Amanda received bills from her doctor as well as the hospital.
She was confused and upset because she expected that the bills would be covered by her insurance.
She called Health Advocate. Amanda’s Personal Health Advocate:
- Contacted the health plan, who updated an eligibility issue pertaining to the doctor’s claim, and the claim was successfully reprocessed
- Explained to Amanda that the doctor’s bill was paid in full, but the hospital bill required an appeal
- Uncovered that the health plan required a notification from the hospital to authorize an extended stay for the newborn
- Coordinated the appeal between the hospital and the carrier
- The appeal was successful and Amanda was relieved to learn that the hospital bill was also paid in full
- +Concierge-level Service
A large wireless telecommunications company needed help designing an employee benefit plan to drive high-value care choices, promote good health and maximize benefits while minimizing taxes.
The Health Advocate team worked with the client to design an Advocacy program that increased engagement and reduced costs.
- Concierge-level service helps employees get to the right care, at the right time, from the right in-network providers
- Expert resources guide employees through benefit changes
- Helps employees understand how much health services cost before using them