- Economics and finance: The release of a new must-have electronic gadget that sends a business’s stock price soaring and shoppers clamoring to stores.
- Social media: The inspiring story of an ALS patient who prompted a recent wave of charitable giving.
- Events: The Supreme Court’s upholding of the Affordable Care Act, which impacts the group benefit plans provided by most employers.
Granted, my universe is much smaller and contained than the national and global events that feed nightly news broadcasts and Google News updates, yet I see the ripple effect in motion every day.
I manage an employee advocacy center for benefits, BenefitsVIP®. Our service and support reps (we call them advocates) answer questions and resolve issues for our clients’ insurance plan participants. The impact of what we do extends in many directions. For example, a positive ripple effect of advocacy is helping employees better understand and use their benefits, which increases engagement in the plan and promotes insurance consumerism. When you guide a participant to more responsible plan utilization, it can help reduce the employer’s overall healthcare cost. That’s why our advocates listen carefully to what each caller is saying and use the interactions as a coaching or teaching opportunity. (Example: “You went to the ER over the weekend because you had the flu? Did you know that an urgent care facility can handle this kind of illness when your doctor isn’t available, and it’s cheaper too?”)
When employees receive these gentle reminders, a quick response to a routine question, or help resolving a complicated claims issue, they’re happier with the health and welfare benefits their company provides. The employer directly benefits from advocacy too because employees often try to handle issues during working hours. When advocates get involved, employees can get back to work more quickly than if they’d tried to handle the problem on their own.
So it’s true that a high-quality employee advocacy center can help virtually everyone involved in the plan to save time and money. While working with employees we sometimes want a ripple effect to happen, but other times we try to prevent it from occurring. I’d like to share an example:
One of our clients added an in-network deductible of $250 to a healthcare plan for medical services only. The company’s employees learned about the deductible during open enrollment meetings and follow-up benefit plan communications.
Shortly after the health insurance renewal went into effect, BenefitsVIP received a call from this company’s employee who had encountered an issue with the deductible while paying for a prescription at a pharmacy. The pharmacist told the employee that the carrier had applied the deductible to his prescription and he was responsible for paying the full amount of the drug. It’s obvious that the employee had been paying close attention during the open enrollment meeting and had read the benefit plan communications. His reaction was that the deductible had been applied incorrectly and he called BenefitsVIP for help sorting it out.
Our advocate who took the call suspected the carrier may have incorrectly coded its system to include prescriptions in the deductible. He was in the middle of writing an email to the carrier about his suspicions when he received a second call from another employee who’d also encountered an issue with the deductible. This employee had been charged $300 for a prescription drug with $250 applied toward the deductible and a $50 copay. The second call confirmed that the issue was a coding error.
Our advocate contacted the carrier, confirmed that a coding error had actually occurred, and the situation was resolved within 48 hours. He also arranged for an override so that both affected employees would be charged only the copay for their prescriptions.
While that’s a happy ending for everyone, there is more to the story. Our rep’s action not only prevented other members on our client’s health insurance plan from being inconvenienced by the same issue, the coding error could have impacted 20% of the carrier’s entire book of business (4.4 million members). That’s a ripple effect that no one wanted, and the quick action of our advocate and the carrier prevented a lot of headaches and hassles. If you’re interested in learning more about this case, you can find information here.
Benefits are complicated by nature and there are a lot of behind-the-scene factors that come into play when plan participants seek medical treatment or buy a prescription. Employee advocacy can help smooth the ripples.
- Why doctors should educate employees about healthcare costs
- Empower your employees—treat them like insurance consumers
- How technology decodes the impact of benefit plan decisions
©2015 Corporate Synergies Group, LLC. No part of this material may be republished or distributed without prior written consent.