If your health plan is considering adding a health advocate service (also called health advocacy, healthcare navigation or health plan concierge services) as a benefit for members, you may want to know the types of questions that can be answered by the typical advocacy program specialist.
First, a definition of a health advocacy service: High-touch, concierge-level support for individuals (plan members, employees) that helps and empowers them to easily navigate the complex healthcare system, access the right care, make informed decisions and spend the healthcare dollars wisely. A health advocate serves as a guide and problem-solver who is there to hold a member’s hand throughout the healthcare journey. Changing and more complicated healthcare delivery models and the need for an improved member experience have led many health plans to offer this kind of advocacy solution.
Advocacy services are usually reachable via a toll-free number given out by the health plan or employer. An advocate is assigned to an individual and will continue working with that person until the issue is resolved. An advocate’s goal will then be to provide information and resolve issues, whether it has to do with a medical billing error, denied claim, benefits choices, health savings account rules or how to get a specialist referral.
Here are a few examples of questions that health advocates can answer:
- Which benefits plan makes the most sense for my family?
- How much have I spent toward my deductible?
- Will my plan cover the new drug my provider prescribed?
- What do I need to do to get approved for surgery?
- What happens if I don’t use all funds in my HSA or FSA?
- How do I get a specialist referral, appointment and records transfer?
- What do I do if my claim is denied?
- How do I determine if this surprise medical bill is legitimate?
- Can I get help with transportation to and from my outpatient surgery?
- Will my insurance cover getting a second opinion?
- Who is the best doctor in my area for treating my condition?
- Will this lab work my physician ordered be covered?
- How do I transfer my x-rays to another provider?
- Can you help me arrange post-discharge home care?
- Who can help me find assisted living care for my parent?
- Who can explain this explanation of benefits I received?
- Can you help me find clinical trials?
- How can I save money on prescriptions?
- What is my copay for this treatment?
- What do I need to do to transition to Medicare?
You can find additional information on the value and content of these types of health advocacy programs in our ebook, Why Joining the Concierge Movement Is Critical for Meeting Employer Needs and Consumer Expectations.