I’d like to share a story about why I’m so passionate about employee advocacy.
One of our clients’ employees has a 6-year-old child who suffers from extreme allergies and whose only food source is a prescription nutritional formula. Due to her confusion about who was to supply the formula under her insurance plan, the employee mistakenly ordered the prescription from a medical supplier. When the insurance carrier wouldn’t cover the cost of the formula, the medical supplier abruptly cancelled the order. The employee had tried unsuccessfully to resolve the issue with the carrier, and she had only a three-day supply of the prescription on hand. She called our internal employee advocacy and support center, BenefitsVIP, at 7:30 on a Friday night, and was understandably upset.
Despite the hour, one of our BenefitsVIP service reps (we call them advocates) went right to work. She called the carrier on the employee’s behalf and learned the insurance plan would cover the cost of the prescription formula only if it was ordered through a retail pharmacy, not a medical supplier. Our advocate quickly located a pharmacy that agreed to special-order the formula. The employee also had a bad back and was unable to load the case of formula into her car. So our advocate arranged for the pharmacy to ship it directly to her home and the formula arrived over the same weekend. You can imagine the employee’s relief when she learned the issue was resolved and her child’s food source would not be disrupted.
While this may seem a unique example of the valuable work conducted by BenefitsVIP, it certainly isn’t unusual. Although our advocacy teams receive a good share of “I’ve lost my wallet card” variety of phone calls, they often resolve larger issues like the situation I described above.
Our advocates also handle complex claims that save employees money. An employee who suffered a heart attack was rushed to the closest medical center for emergency treatment. He later received a bill for $21,000 because the hospital was outside his insurance plan’s network. He couldn’t convince the carrier that he had no choice but to use that particular hospital—he’d sought treatment for a heart attack, after all—but the carrier stood by its policy. The employee would have to pay the higher out-of-network share of the treatment cost. One of our BenefitsVIP advocates stepped in and worked with the facility to provide the necessary reports to show the life-threatening nature of the emergency care. The employee’s financial responsibility was reduced $19,000, a 90% cost savings. That’s the power of an employee advocacy center like BenefitsVIP.
We all know that benefits are complicated. The experience of navigating through the healthcare system is often daunting and intimidating, and that’s why employee advocacy is so important. Our advocates know the right channels to pursue to get an issue resolved. It’s a sigh of relief for an employee who’s used to waiting on hold for what turns out to be the wrong person or the wrong answer. At BenefitsVIP, we notice that the employees we’ve helped continue to call us again and again and refer us to their coworkers.
For our part, we find that most employee interactions lead to what we call “coachable moments” where we make sure employees are educated on how to best use their benefit plans. Ultimately, these coachable moments impact employees by resulting in lower out-of-pocket expenses. For example, we often find that employees on some plans don’t realize they have access to urgent care centers and 24-hour nurse lines. Both can reduce costly and unnecessary visits to the emergency room, and that’s a gain for the employee, the client and the entire healthcare system. Also, when employees call about the high out-of-pocket costs of their brand name prescriptions, we educate them on the availability of generic drugs and how to take advantage of mail order options. These are just two examples of coachable moments that can lead to cost savings for our clients and their employees.
Clients appreciate the support we provide their employees as well as the reduced workload due to our involvement. The bottom line is that we enjoy helping people, and by extension helping the organizations for which they work.
Our clients trust us with their most valuable asset: their employees and that’s why employee advocacy matters!