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Navigating healthcare is complex enough for expert benefits professionals – never mind the confusion that average employees face when trying to resolve claims or billing issues. Research shows that just 14% of Americans can correctly define common health insurance terms like deductible, coinsurance, and out-of-pocket maximum. That lack of knowledge makes disputing claims complicated and scary for many employees. That’s why we partnered with West Corporation. West’s team of trained Personal Health Advocates are skilled at working with healthcare providers, insurance plans and other health-related organizations to resolve complex clinical and administrative issues. With our partnership, your employees have access to industry experts who will provide one-on-one, confidential guidance.
- Resolve Benefits and Claims Issues: West’s team will review coverage and help members understand the rules that apply to their benefits. They will investigate benefits and claim denials and review a member’s outstanding out-of-pocket responsibilities. Their team will attempt to resolve errors with providers and/or health plans or plan administrators including resolving coordination of benefits disputes between multiple carriers or carrier types
- Educate Members about Benefit Coverage: They will explain difficult-to-understand terms and how coverages may vary. They also help employees understand the differences in their spending accounts and what is eligible for reimbursement.
- Fee Negotiation: They will attempt to assist members dealing with a bill for an out-of-network service, or for a service not covered by their health plan, that exceeds $400 by negotiating with the provider to lower the fee or arrange a payment plan.
- Appeals Information: Their experts will provide information to members regarding their appeal rights and help them understand the appeals process.