To give you a sense of what and how Benefit Advocates does, here are some typical case summaries and testimonials.
Air Ambulance Bill
An individual was being billed over $12,000 for an air ambulance required for his son. The insurance company had denied payment to the provider saying it was medically unnecessary for the situation based on what the provider had indicated. Benefit Advocates realized the provider was not in compliance with the insurance company by billing the member. At Benefit Advocates’ prompting, the insurance company contacted the provider to advise that the charges must be written off. Once the provider was faced with this fact, they then provided the insurance company with the correct information in order to get the claim paid. And instead of paying $12,000, the individual ended up with a bill of around $100 to pay because an advocate got involved in the situation.
A Medicare Coordination of Benefits issue arose when a spouse who was on the actively working employee’s insurance plan was about to turn 65. An advocate determined which entity, the employer’s medical plan or Medicare, was the actual primary payer for any medical claims, and changes were made accordingly with the employee’s spouse’s Medicare plan to fix the problem. Benefit Advocates was able to cut through all the misinformation the employee and spouse had received and redirected them to the correct solution.
Cost of Insulin
A sharp price increase in her daughter’s insulin caused an employee to reach out to Benefit Advocates to see if it was a mistake or the new reality. The advocate questioned the Rx insurance company and communicated with the employer’s HR department. The advocate’s steps led to the discovery that an overlooked plan benefit needed to be reinstated for the new plan year. In the end, the advocate was glad to let the employee know that the cost of her daughter’s insulin would remain at the same level they had been paying during the previous year.
COMMENTS REGARDING POSITIVE OUTCOMES:
- “I’m sure it would not have happened without your involvement. Thank you again!”
- “Thank you so much! This makes me feel so much better.”
- “AWESOME!!! Thank you again for all your assistance in getting this resolved.”
- “You are a gem! Thanks so much!”
- “Thank you so much for your assistance. It sounds like this will get resolved for now and going forward.”
- “I really appreciate how quickly you handled this matter. I just got a call from the provider and UHC has approved the surgery! Thank you so much! You dropped everything you were doing to help me. There is no doubt in my mind that you and your UHC Rep played a huge part in getting this approved for me!”
- “Oh my goodness – thank you Cindy for everything! Finally, after all the paper chasing and phone calls. Thanks so much for all of your help. You are the best. I sing your praises all the time around here.”
COMMENTS REGARDING INFORMATION RECEIVED:
- “Thank you for this – it is very helpful!!”
- “Thanks for getting back to me so quickly. I really appreciate it.”
COMMENTS FROM CUSTOMER SATISFACTION SURVEYS:
- “The advocate understood the situation, was clear and also very aware of how the process worked.”
- This person said the experience with the advocate was a great deal better than they expected because “She [the advocate] listened to all that I had to say and clarified with the pharmacy and insurance company.”
- This person said they were extremely satisfied with the customer service and added that “The advocate was very professional and able to resolve my issues. The advocate was sensitive to my personal stress that was caused by my situation.”
- “I really appreciated my advocate’s helpful attitude.”