Learn how to utilize 24/7 Healthcare Advocacy to streamline operations, increase customer service & retention and offer peace-of-mind to clients and plan members.

1. HEALTHCARE ADVOCACY
TELEMEDICINE WELLNESS RX MANAGEMENT

3. NAVIGATING HEALTHCARE
PROCEED WITH CAUTION

4. You and Your Team Face Increased
Responsibilities all while trying to
Deliver 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

5. 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
technology instead of in person.
The Insurance Consumer has
Changed. Have you?

6. Move from Broker to Trusted Advisor
Stay on Top of
Legislation and
Industry Trends
Managing Healthcare
Timelines and Enrollment
Process
ACA and
Compliance
Checklist

7. Plan Members find Navigating Healthcare to be Very Confusing
What’s
Covered in
My Plan?
Mandatory
Second
Opinions
Scheduling
Appointments
Locating
Care
Providers
Brand or
Generic
Drugs?
In or
Out of
Network?
Finding
Convenient
Facilities

8. Supporting a Consumer requires a New Dimension of
Information and Solutions
What
should I do?
Where
should I go?
How much
will it cost?
Cost Transparency and
Medical Bill Review
Provider Search
and Scheduling
Evaluate and Compare
Treatment Options
$

9. 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?

10. Assist your Clients with Cloud Based Collaboration of
Subject Matter Experts (SMEs)

11. Clinician, RNs
and Medical
Advocates
Insurance
and Benefit
Professionals
Pharmacy
and Treatment
Specialists
Provider Relations and
Claims Coordinators
Meet Our Subject Matter Experts

12. • Dedicated Toll Free Numbers
• Advocate Resources
• Transparency Tools
• Chat Box Options
• Responsive Website
High Tech, High Touch

13. 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

14. General Plan Questions •
Assistance with Copayments, •
Deductible & Out-of-Pocket Costs
Clarify Covered Services •
Understanding Pharmacy •
Benefits & Formularies
PLAN BASICS:
Explanation &
Understanding Of
Benefits

15. • Finding In-Network Providers,
Treatments & Facilities
• Get Second Opinions & Alternative
Care Options
• Schedule Appointments & Transfer
Medical Records
• Compare Cost & Quality
FINDING CARE:
Transparency & Access

16. • Claims Explanation & Support
• Medical Bill Reviews & Audits
• Fee & Payment Negotiation
• Appeals & Approvals
PROBLEM
SOLVING:
Hands-On Support &
Solutions

17. Rx Medication Review •
Cost Savings Options •
Case Management Support •
One-to-One Preventative Care Planning •
PERSONAL CARE:
Individual Solutions

18. Activity Summary Reports
• Employee / Member Count
• Number of Interactions
• Distribution of Call Categories
• Easy to Understand Usage Chart
Activity Reports Include

19. 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 bring
value and improve
client retention and
relationships.
We provide
customized reports
that reinforce
program value.
Create a Differentiator

20. Become a Trusted Advisor
• Add Value and Enhance Client Relationships
• Improve Productivity and Retention
• Provide Expertise
• Stand Out in the Market
Healthcare. Confusion. Simplified.

21. HEALTHCARE ADVOCACY
TELEMEDICINE WELLNESS RX MANAGEMENT
THANK YOU