What is a benefits advocate?
At some point in our lives, we all become patients. Sometimes it’s a simple checkup, other times it’s a medical emergency.
Most health insurance holders know how to use their insurance for routine medical tasks – like making a doctor’s appointment or using a flexible spending account debit card to buy band aids at the pharmacy.
But when medical questions arise, health insurance companies are notorious for being difficult to get ahold of. That’s where a benefits advocate comes in.
What is a benefits advocate?
Benefits advocates are all-knowing health insurance gurus. They are a plan participant’s first- resource when it comes to questions or concerns – big or small – regarding the nuances of their specific health plan.
What does a benefits advocate do?
From insurance claims, to billing errors, to specific questions about how a plan works, benefits advocates are trained to have the answers you are looking for.
Benefits advocates understand the complex nuances of health insurance and work directly with the carriers to resolve any plan-related issue, eliminating the need for plan participants to call the carriers directly.
How benefits advocates help employers and health plan members
Let’s say your dependent had a long-term hospital stay. The hospital gives you good news that your dependent’s condition is improving, but they have a large influx of patients in need of critical care, so they would like to relocate your loved one to a different facility to make space for more critical cases. You agree, and you work with the hospital to secure a transfer to a different hospital.
Although the facility your dependent is being transferred to is out-of-network, you are told that a GAPP exception would be made for this special case – so all your rates will process as in-network.
A week or so later, you and your loved one finally return home – only to be greeted by a staggering hospital bill full of out-of-network rates you were told you wouldn’t be charged for.
This situation actually happened to a Caravus client’s employee and their family. Read the full story here!
This scenario is where a benefits advocate would step in. They would work with your insurance carrier, managing all the phone calls, emails, and necessary documentation filing, to remedy the issue on your behalf.
Cost savings and employee benefit advocates
A recent study estimated that Americans spend 12 million hours calling insurance carriers looking for answers about their plan – and most of those calls happen during work hours. This costs US businesses over $95 million dollars per year in lost productivity.
When your employees work with an advocate, the days of figuring out the nuances of a complicated plan or difficult claims situation are over. The added benefits (and cost savings) employers see when working with an advocate are:
Increased productivity
Happier, healthier, less stressed employees
Better utilization of benefits
While some health insurance brokers do have individuals that help with client claim and billing issues, it is not common practice for a broker to have a dedicated employee benefits advocate.
At Caravus, our benefits experts know just how confusing and overwhelming insurance claim issues are, and we wanted to remove that burden from our clients and their employees. Our advocacy team ensures all our clients and their employees receive the help they need when it comes to these complex issues.
Our advocacy team is just the beginning when it comes to how we help clients navigate the complex world of healthcare. To learn more about how Caravus can help simplify your choices in health coverage, visit www.caravus.com or contact us today.