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HEALTHCARE ADVOCACYTELEMEDICINE WELLNESS RX MANAGEMENT
NAVIGATING HEALTHCARE
PROCEED WITH CAUTION
You and Your Team Face Increased Responsibilities all while trying toDeliver Significant Value
• Time tracking for variable hour employees• Full-time employees and equivalents calculation• Plan affordability analysis
ACA Reporting
• Data gathered automatically from payroll• End-of-year printing and mailing to employees• Completed employer forms filed with the IRS
Forms 1094 and 1095
• Penalty exposure warning• What-if simulations• Checklist to keep you on track
ACA Compliance
Today’s Consumers have grown accustomed to:
• Instant access to every piece of information.• Expecting more services to be available 24/7.• More comfortable connecting with people and
businesses through technology instead of in person.
The Insurance Consumer has Changed. Have you?
Move from Broker to Trusted Advisor
Stay on Top of Legislation and Industry Trends
Managing Healthcare
Timelines and Enrollment Process
ACA and Compliance
Checklist
Plan Members find Navigating Healthcare to be Very Confusing
What’s Covered in My Plan?
Mandatory Second
Opinions
Scheduling Appointments
Locating Care
ProvidersBrand or Generic Drugs?
In orOut of
Network?
Finding Convenient
Facilities
Supporting a Consumer requires a New Dimension of Information and Solutions
Whatshould I do?
Whereshould I go?
How muchwill it cost?
Cost Transparency and Medical Bill
Review
Provider Search and Scheduling
Evaluate and CompareTreatment Options
$
We help with answers and get results.
• Help in understanding your health plan• Find the Right Doctor, Hospital• Schedule Tests, Appointments, Second Opinions• Get cost estimates for procedures• Resolve billing issues• Perform medical record transfers
How does Healthcare Advocacy Help Members?
Assist your Clients with Cloud Based Collaboration of Subject Matter Experts (SMEs)
Clinician, RNsand Medical Advocates
Insuranceand Benefit
Professionals
Pharmacyand
Treatment Specialists
Provider Relations and
Claims Coordinators
Meet Our Subject Matter Experts
• Dedicated Toll Free Numbers• Advocate Resources• Transparency Tools• Chat Box Options• Responsive Website
High Tech, High Touch
General Plan Questions • Assistance with Copayments, •
Deductible & Out-of-Pocket Costs Clarify Covered Services •
Understanding Pharmacy •Benefits & Formularies
PLAN BASICS: Explanation &
Understanding Of Benefits
• Finding In-Network Providers, Treatments & Facilities• Get Second Opinions & Alternative
Care Options• Schedule Appointments & Transfer
Medical Records• Compare Cost & Quality
FINDING CARE: Transparency & Access
• Claims Explanation & Support•Medical Bill Reviews & Audits• Fee & Payment Negotiation• Appeals & Approvals
PROBLEM SOLVING: Hands-On Support & Solutions
Rx Medication Review •Cost Savings Options •
Case Management Support •One-to-One Preventative Care Planning •
PERSONAL CARE: Individual Solutions
Rx Medication Review •Cost Savings Options •
Case Management Support •One-to-One Preventative Care Planning •
PERSONAL CARE: Individual Solutions
• Finding In-Network Providers, Treatments & Facilities• Get Second Opinions & Alternative
Care Options• Schedule Appointments & Transfer
Medical Records• Compare Cost & Quality
FINDING CARE: Transparency & Access
• Claims Explanation & Support•Medical Bill Reviews & Audits• Fee & Payment Negotiation• Appeals & Approvals
PROBLEM SOLVING: Hands-On Support & Solutions
General Plan Questions • Assistance with Copayments, •
Deductible & Out-of-Pocket Costs Clarify Covered Services •
Understanding Pharmacy •Benefits & Formularies
PLAN BASICS: Explanation &
Understanding Of Benefits
General Plan Questions • Assistance with Copayments, •
Deductible & Out-of-Pocket Costs Clarify Covered Services •
Understanding Pharmacy •Benefits & Formularies
PLAN BASICS: Explanation &
Understanding Of Benefits
• Finding In-Network Providers, Treatments & Facilities• Get Second Opinions & Alternative
Care Options• Schedule Appointments & Transfer
Medical Records• Compare Cost & Quality
FINDING CARE: Transparency & Access
• Claims Explanation & Support•Medical Bill Reviews & Audits• Fee & Payment Negotiation• Appeals & Approvals
PROBLEM SOLVING: Hands-On Support & Solutions
Rx Medication Review •Cost Savings Options •
Case Management Support •One-to-One Preventative Care Planning •
PERSONAL CARE: Individual Solutions
• Claims Explanation & Support•Medical Bill Reviews & Audits• Fee & Payment Negotiation• Appeals & Approvals
PROBLEM SOLVING: Hands-On Support & Solutions
• Finding In-Network Providers, Treatments & Facilities• Get Second Opinions & Alternative
Care Options• Schedule Appointments & Transfer
Medical Records• Compare Cost & Quality
FINDING CARE: Transparency & Access
Rx Medication Review •Cost Savings Options •
Case Management Support •One-to-One Preventative Care Planning •
PERSONAL CARE: Individual Solutions
General Plan Questions • Assistance with Copayments, •
Deductible & Out-of-Pocket Costs Clarify Covered Services •
Understanding Pharmacy •Benefits & Formularies
PLAN BASICS: Explanation &
Understanding Of Benefits
Rx Medication Review •Cost Savings Options •
Case Management Support •One-to-One Preventative Care Planning •
PERSONAL CARE: Individual Solutions
• Finding In-Network Providers, Treatments & Facilities• Get Second Opinions & Alternative
Care Options• Schedule Appointments & Transfer
Medical Records• Compare Cost & Quality
FINDING CARE: Transparency & Access
• Claims Explanation & Support•Medical Bill Reviews & Audits• Fee & Payment Negotiation• Appeals & Approvals
PROBLEM SOLVING: Hands-On Support & Solutions
General Plan Questions • Assistance with Copayments, •
Deductible & Out-of-Pocket Costs Clarify Covered Services •
Understanding Pharmacy •Benefits & Formularies
PLAN BASICS: Explanation &
Understanding Of Benefits
Activity Summary Reports
• Employee / Member Count• Number of Interactions• Distribution of Call Categories• Easy to Understand Usage Chart
Activity Reports Include
We answer the phone 24/7 with
your agency name and greeting.
We free up agency staff to focus on growing the
business.
We customize
our materials to promote
your company and
brand.
We bringvalue and improve
client retention and relationships.
We provide customized reports that
reinforce program value.
Create a Differentiator
Become a Trusted Advisor
• Add Value and Enhance Client Relationships• Improve Productivity and Retention• Provide Expertise• Stand Out in the Market
Healthcare. Confusion. Simplified.
HEALTHCARE ADVOCACYTELEMEDICINE WELLNESS RX MANAGEMENT
THANK YOU