We all know how confusing health care can be. Between copays, eligible expenses and dense coverage policies, sometimes it feels like you need a master’s degree just to understand your hospital bill. And with high deductible health plans gaining popularity each year, it’s critical that employees understand what their health decisions are costing them. This is where health advocacy services — sometimes called patient advocacy — can help.
This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.
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What are Health Advocacy Services?
Health advocacy services are basically what they sound like: having a personal advocate who will fight for your best health interests. Imagine a seasoned industry professional who can help you untangle the web of health care and insurance mumbo jumbo.
These are just some of the services health advocates may offer:
- Coordinating care for chronic or complex medical conditions
- Explaining medical bills
- Settling insurance billing issues
- Arranging hospice or elder care
- Clarifying benefits coverage
In a nutshell, think of health advocacy services as an extension of your HR department—existing to help employees with any health care concern.
Who Can Receive These Services?
Health advocates are available to anyone who needs help navigating the murky waters of health care. Sometimes individuals may even seek out an advocate on their own. This typically happens when someone is drowning under a mess of health care circumstances. For example, inheriting the bills of a loved one who passed away after undergoing complex medical care.
A more common scenario is an employer offering health advocacy services to their employees as part of a benefits package. Employees could still receive the same services, but not have to worry about the cost of their consultations—a common reason why individuals shy away from these helpful services.
Benefits for Employees
Beyond the services listed earlier, here are some other benefits a health advocate can provide:
- Acquiring medical equipment needed after leaving the hospital
- Disputing benefit claim denials
- Arranging the transfer of medical records
- Helping make sense of prescription drugs and their usage
- Explaining other services like massage therapy and acupuncture
Above all, peace of mind is perhaps the largest benefit for employees. Imagine the relief if someone told you they will help you coordinate your chronic care. Sounds good, right? Employees can lay out all their health concerns and a professional will help explain everything.
Most advocates are available at any hour of the day, meaning employees will never have to worry about rearranging their schedules. Any time they have a question, an advocate will be there.
Benefits for Your Company
Instead of an employer or HR dealing with complicated employee health questions, a trusted resource does it instead. This not only frees up your time, but shortens response times for employees.
Another benefit is employee productivity. These services can help employees focus on work instead of a health care nightmare at home. This makes health advocacy a win-win for them and your company.
Who Pays?
Many health advocacy groups are independent from insurance carriers. This means insurance will not cover their services. But some carriers do have their own advocates who can assist employees, free of charge, although this is less common.
Health advocacy services can range anywhere from $40 an hour to a couple hundred dollars, depending on the organization and the service. However, many groups will negotiate a contract of just a few dollars per employee, per month. This makes health advocacy most affordable when offered through your company, instead of employees seeking it out on their own.
Considerations
Since some health advocates work directly for insurance carriers, you must consider what benefits they may have. For instance, these advocates could provide essential health plan perspective that others could not.
However, contracting with an independent group may provide the most peace of mind for your employee. Since these groups are not employed by insurance providers, employees can be certain that their needs are coming first.
Another consideration is that many disputes handled by health advocates stem from underlying plan issues. For instance, many employees seek help handling an unpaid claim or help understanding their treatment options under a plan. In both cases, critics argue that the plans themselves should be reassessed, rather than employing advocates to explain them. In other words, a simpler plan design or more employee communication materials may be more effective in the long run.
Summary
Offering health advocacy services can be a cost-effective way to satisfy your employees and the HR department, but it’s not for everyone. Deciding which group to contract with will depend on factors like price and services offered to ensure the right fit for your company. Consider surveying employees to determine if an advocate group or plan changes would be most beneficial for your company.
Speak with TPG Insurance Services for more information.
