Health Advocacy Services

The purpose of Health Advocacy Services is for you to have your very own “Advocate” who can help you and your covered dependents navigate the healthcare system and deal with the clinical and administrative issues you have to face to meet your medical, hospital, pharmacy and other healthcare needs.

Advocates are specially trained to handle every matter in a thoroughly confidential manner and to follow strict protocols that comply with all government privacy standards to ensure your medical and personal information is properly protected.

Your Advocate and the team of administrative experts who work with your Advocate are all committed to giving you top-quality service and support. Furthermore, Advocates can help you identify primary and specialist physicians, hospitals, and related healthcare providers. While they will focus on taking advantages of network relationships to help you get the most from your benefits, they can also work to use out-of-network providers and suppliers for any necessary healthcare, supplies and equipment not available for in-network sources.

Your Advocate can explain the coding and payment rules that apply to your circumstances and help sort out and solve claims and related paperwork problems and assist with revolving coverage issues and disputes. They will research your out-of-pocket payment responsibilities, resolve any errors related to balance-billing, eligibility, benefit of claim denials with providers and/ or the insurance company.

When necessary, they can negotiate for fee reductions from healthcare providers to lower your erroneous charges and help resolve questions regarding denials of benefits deemed to be non-covered, not medically necessary or ineligible. If there are questions of coverage for a particular, or if coverage for clinical care has been denied, your Advocate can assist you throughout the review and appeals process. They can also assist in searching out alternative coverage options when needed.

Your Advocate can assist you with prescription medication issues including formulary and benefit questions, provide information on generic drugs, locating lower cost sources for prescription medications not covered by your health plan and help you obtain mail order prescriptions.

Advocates are not affiliated with any insurance or third party provider. Healthcare Advocacy Services does not replace health insurance coverage, and Advocates do not provide medical care, render medical advice or recommended medical treatment.

Contact us at Member Services 1-866-227-5400 Monday thru Friday 9 am to 5:30 pm EST.Please have your Member Number available.

Leave a Reply