Diversified Benefit Services Inc. strongly believes in the business proposition of Value Added Service. Any licensed agent can sell a policy, but our strength lies in our ability to deliver Outstanding Customer Service and cutting-edge Technical Expertise.
DBS was the first regional firm to offer bilingual person-to-person enrollment & benefit orientation service for our clients. Acting as a “second pair of hands” has helped to relieve busy HR personnel of these extra duties. Additionally, employees appreciate the privacy of thoroughly discussing their enrollment options and best choices for their family circumstances and health status. Employees are encouraged to call us first, with questions, “what if” scenarios, provider issues, and claim or eligibility problems, again relieving the employer of the responsibility and potential liabilities associated with discussing personal medical or financial information.
When you select DBS as your employee benefits firm you have put yourself among those employers who want their employees to receive full-value from the benefit plans you provide. We furnish these services not as an add-on that you must pay extra for, but at no additional cost because we believe it is part of our obligation as your service vendor, to you as well as to your employees.
Sometimes we are amazed that businesses will pay brokers, consultants, carrier reps, financial counselors or specialized HR Staff, and still need to contract out (at an addtional cost) for employee advocacy. The article below cites this growing trend. We hope you are, or will become amazed with our dedication and service ethic to you and the families who depend upon your employee benefit program.
Advocacy Builds Better Consumers
Jill Elswick
Employee Benefit News ? September 1, 2002
In an environment of rising health care “consumerism” and imminent patient privacy requirements, some employers are providing advocacy services as an employee benefit to help plan participants and their families navigate an increasingly stormy and complex health care system.
Evidence suggests such services may be badly needed. Most mistakes, such as inappropriate care denials and billing errors, originate not with consumers but with plan administrators (54%) and care providers (17%), according to Hewitt Associates. The consulting firm tracked 2,500 problems reported to its participant advocacy services department over an 18-month period from January 2000 to June 2001.
Foreign Language
“The average consumer struggles with the health care system, because it’s a foreign language and it’s intimidating,” says Jane Cooper, president and CEO of Patient Care, a patient advocacy product of New Orleans-based Labyrinth HealthCare Group. “People are frustrated because they pay a lot of money for insurance, then they end up getting a bill from the anesthesiologist.”
Established in 2001, Patient Care has 22 employer-clients representing 3,000 employees in seven states. In the first quarter of 2002, 52% of service calls related to claims issues, while other calls concerned general information (21%), access to care (14%), pharmacy (8%), and eligibility (4%).
Some callers want to know how certain benefits of their plan work. Others wonder why the neighborhood pharmacy has told them their prescription is no longer “on the list.” A caller with skin cancer successfully challenged, with the help of Patient Care’s medical director, the steep co-payments associated with his bi-weekly ultraviolet treatments.
Looming privacy requirements under the Health Insurance Portability and Accountability Act (HIPAA) appear to be driving much of the interest in patient advocacy services, says Cooper. That’s true for New Orleans-based Whitney Holding Corp., which signed with Patient Care this year for its 2,500 employees and their covered dependents.
“The biggest reason we had for doing this was concern over our ability to serve internal customers,” says Beverly White, vice president and employee benefit manager. “HIPAA regulations are making it difficult for us to intervene on behalf of employees because the insurance companies are becoming increasingly reluctant and will only deal with select people from the benefits staff.”
White cites “great response” to the service from employees: “They react a little bit quicker with Patient Care because it’s anonymous. They can pick up the phone and call them and not have to discuss their personal business with someone in human resources.”
Depending on company size, Patient Care charges $1.25 to $4 per employee per month. White says it’s worth it: “There’s the advantage of enhanced productivity, so employees don’t have to spend hours on the phone. I think it reduces emotional stress. I will tell you it’s reduced my phone calls from employees.”
Staff Replacement
Michael Tovar, director of compensation and benefits for Vernon Hills, Ill.-based liquid packaging company Tetra Pak, turned to patient advocacy firm CareCounsel in April 2000 after an uncomfortable stint answering benefit questions at his 1,300-employee company.
“Our benefits person had left and I had to man the phones for about three months until we got somebody else,” recalls Tovar. “It starts hitting me: The amount of information, personal health information, I’m finding out about people. I mean, some ugly stuff.”
While rummaging through material he’d picked up at a benefits conference, Tovar found CareCounsel. Based in San Rafael, Calif., the company has been in the patient advocacy business since 1996. With 20-odd clients, including big names like Bristol-Myers Squibb and Hitachi Data Systems, CareCounsel serves 26,000 employees and their families.
CareCounsel typically charges $2 to $2.50 per employee per month, depending on the size of the group, whether it includes retirees, and the complexity of the health plan.
Tovar estimates the service replaces “75% to 80% of a full-time person” and saves Tetra Pak at least $40,000 annually. While many calls relate to claims, network access, and eligibility, the company also receives a large number of requests for general educational information, says CareCounsel CEO Larry Gelb.
Typical questions: “What are the 20 questions I should ask when choosing a primary care provider? Where can I get quality data? Should I use my EAP or my mental health benefit?” Tip sheets on subjects such as usual-and-customary rates help answer frequently asked questions.
But CareCounsel also steps in to solve very specific needs, says Gelb, such as finding a support group for parents of diabetic children in Cleveland or hounding a mental health carve-out plan to grant a quick appointment to a violently troubled patient.
This patient’s call “had that John Q. type of feeling,” recalls Gelb. “That’s where, listening with our third ear, we said, We’ll work on the systems issue, but why don’t you talk to your employee assistance program?’”
The EAP was so concerned it sent police to evaluate the man, whose mental health carve-out plan eventually granted an appointment after a week of daily calls from Care-Counsel. Events may have unfolded quite differently without the intervention.
Growing Market
Further proof that patient advocacy services are poised to join mainstream employee benefits: Former top executives at Aetna U.S. Healthcare formed West Conshohocken, Pa.-based Health Advocate last fall.
During the first six months of 2002, Health Advocate says it “enrolled more than 50 employers and group sponsors, covering more than 80,000 individuals,” with clients including Subaru of North America, Westinghouse, Magellan Health Services, and Advanta.
Health Advocate’s goal is “to help fill the gaps in the health care delivery system for the average consumer,” says Arthur Leibowitz, M.D., executive vice president and chief medical officer. As former chief medical officer of Aetna U.S. Healthcare, it often fell to Leibowitz to handle complaints of client VIPs. He envisioned doing the same for typical plan participants.
“Your employees can muddle their way along and deal with the health care system,” Leibowitz tells employers. “However, if they do so, they will not be working. The health care system, by and large, operates between 9 o’clock in the morning and 5 o’clock in the afternoon.”
Nearly half of Health Advocate’s services involve “connecting people to clinical care,” says Leibowitz. One woman had been to nine doctors for headaches but still endured blinding migraines. Health Advocate introduced her to a neurologist who specializes in headaches and “in two visits her headaches were gone.”
In another case, a woman whose husband had suffered a stroke couldn’t afford to hire a full-time nurse at $30,000 per year. Health Advocate cobbled together a program that included community-based transportation, adult day care, and a YMCA program for seniors all for $110 a week.
Health Advocate’s services cost about $3 per employee per month, but the company also sells banks of time at roughly $100 an hour. Stanley Uhr, vice president and corporate counsel for Philadelphia, Pa.-based Deb Shops says the benefits outweigh the costs of providing Health Advocate.
“They’re able to get through insurance problems because they understand the system. Something that would take us 10 hours they can do in 15 or 30 minutes,” says Uhr. “I believe every person in this country needs a health advocate.” -J.E.
Copyright © 2001 IMG Media, a division of Thomson Financial. All rights reserved.
Additional Sources of Information:
Consumer Guide to Handling Disputes With Your Private or Employer Health Plan
Prepared by the Kaiser Family Foundation
Which Medical Specialist For You?
Prepared by the American Board of Medical Specialities
Five Steps to Safer Health Care
Prepared by the Centers for Medicare & Medicaid Services
Your Rights as an HMO Patient
Prepared by the California Department of Managed Health Care
