On the surface, health & welfare benefits can seem a little uninteresting, but for the people who work in BenefitsVIP®, our employee advocacy center, their days are anything but dull. When our representatives (we call them advocates) answer a phone call, open an email, or read a live chat message from someone needing help with their benefits, things can get very interesting.
I like to think of our brand of employee advocacy as being more art than science. That’s because it takes a combination of creativity, experience, deeper understanding and empathy to handle the issues we take on for our clients’ employees. Take, for example, the gentleman who had been attempting to get his medical insurance carrier to cover the cost of a new prosthetic knee. John (not his real name) is an amputee and his current knee kept failing despite three major repairs.
Behind every employee advocacy interaction is a very human issue.
John was very concerned he’d fall and hurt himself. The medical device provider he worked with and the knee’s manufacturer both agreed that replacement was the best and safest option. John is an experienced take-charge business manager, so it follows that he would try to work things out with the carrier. But he became very frustrated when they declined to pay for a new knee. The reason for the denial: the medical plan only allowed for a prosthetic replacement if the repair cost was greater than 60% of the price of a new one. Unfortunately for John, the cost to repair the knee was less than 60% of the replacement cost, hence the denial.
When we intervened on John’s behalf and heard the reason for the denial, our advocate escalated the case within the insurance carrier. This is the beauty of our approach: a BenefitsVIP advocate has direct access to carrier decision-makers who are several levels above the customer service rep whom John had talked to when he was working on the claim on his own. Our advocates, who have an average of 23 years of experience in insurance and customer service, know who to call, what to say, what to ask for, how to ask it, and how to respond if they hear the word “no.”
John’s story, like that of many thousands of other BenefitsVIP cases, has a happy ending. After BenefitsVIP became involved, the carrier agreed to cover the $40,000 expense for his new knee. It took 12 days and several calls and emails between Corporate Synergies and the carrier to resolve the issue, but we worked it out.
During our conversations with John, we reminded him to call us first instead of trying to deal with a complicated insurance matter on his own. This reminder is an example of something we refer to as a coachable moment. With each inquirer contact, our advocates work to strengthen their engagement in their personal health and raise their understanding of their benefits as well as what to do if they need help. This is what the ACA refers to as “insurance consumerism” and is one of the main focuses of the law.
Every HR staffer and benefits administrator knows the value of an educated, engaged and connected employee. Ongoing education, whether delivered as coachable moments or via a formal, employee education & communications campaign, is key to building insurance consumerism and engagement in personal health. In order to operate efficiently, a benefits program needs a multi-pronged education strategy. This is especially true if there’s a change in plan design, carriers, or employee contributions.
While we’re solving health & welfare benefits problems and answering questions, we’re always working to fill the knowledge gap. Each year our advocates handle about 50,000 inquiries and issues for our clients’ employees and dependents. They contact us for all kinds of reasons, like requesting a replacement ID card, finding in-network providers, assisting with treatment pre-authorization, and, like John, seeking help with complicated claims issues. We do everything we can to bring cases to a successful conclusion. While we’re helping employees, our clients’ HR staff can step back and take a deep breath because they know their employees are getting the assistance they need.
We recently helped a breast cancer patient who required our assistance getting reimbursed for a “women’s cranial prosthesis,” which is another name for a wig. The cost of a wig is typically covered for patients who experience hair loss due to chemotherapy. The employee had read her plan document and knew that her carrier would pay for the wig, which she purchased for approximately $500. She filed a claim with her carrier and that should have been the end of it. However, the wig vendor wasn’t a participating provider in her carrier’s network and the carrier declined to reimburse the cost.
One of our BenefitsVIP advocates interceded with the carrier, who quickly agreed to reimburse for the cost of the wig as a one-time courtesy exception to the employee. When our advocate delivered the good news to the employee, she reminded her about the importance of using in-network providers, another coachable moment.
Behind every employee advocacy interaction are very human issues, and we see them up-close every day. Ongoing coachable moments, along with a formal employee education strategy, help employees and their dependents avoid mistakes, saving them time and money.
BenefitsVIP lightens the load for HR staffs who are swamped trying to comply with ACA requirements (we hear this all the time). With BenefitsVIP providing support to employees, HR also has more time to work on key initiatives such as employee recruitment and retention.
BenefitsVIP helps employees understand their benefits and use them with confidence. In turn, insurance-savvy benefits consumers help reduce their employer’s healthcare costs. It’s a win-win for everyone.
And for us at BenefitsVIP? Each day we experience the deep satisfaction of helping people and making a real difference.
That’s the art of employee advocacy.
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©2016 Corporate Synergies Group, LLC. No part of this material may be republished or distributed without prior written consent.