1. Sample Employee Interaction Workflow
[date]

2. Employees need help with insurance, benefits or healthcare

3. Health Advocate can help!
When employees are confused and not sure who to call…they can call Health Advocate.
When employees need help that a TPA cannot provide… they can call Health Advocate.
When employees view their digital app and need to talk to someone live…they can call Health Advocate.

4. Innovative Communications
Text codes to get more information
Supports “green” initiatives
Low-cost option for distribution
Member opt-in for text messages
Imprint or stickers on ID cards
Reinforce contact information

5. Health
Advocate
Your Organization
Digital
Platform
TPA

6. Health Advocate is able to assist and educates on gaps in care
Sample issues to call Health Advocate direct for assistance when employee…
Does not feel comfortable calling insurance carrier
Needs help find a specialist for son away at college
Confused about how bariatric surgery will be covered
Moving and needs to find a new doctor and have medical records transferred
Has a large balance bill for an out-of-network claim
Unsure if medical claim was processed correctly
Needs Stress Test, MRI and lab work done on same day
Does not know whether to see a chiropractor, neurologist, orthopedist, or neurosurgeon for back pain
Employee calls
Health
Advocate
Health Advocate is able to assist
and educates on gaps in care
Transfers employee
to appropriate vendor:
Resources for Life
Castlight
Grand Rounds
Doc on Demand
TPA for Disease Management
Centers of Excellence
…or other Client benefit vendor

7. Sample situations for TPA to refer employee to Health Advocate when an employee needs help…
Looking for alternative treatment options
Finding assisted living for father-in-law
Scheduling an appointment with a specialty provider
Arranging for transportation to/from physical therapy
Negotiating a balance bill for a non-covered service
Determining coverage for a child covered on ex- spouse’s health benefits
Transferring records to new doctor
Coordinating multiple tests and services on the same day at the hospital
Employee calls
TPA
TPA is able
to assist
Concern is outside
TPA scope
Refers caller to
Health Advocate

8. Your service team member calls Health Advocate
Examples of situations in which Your Organization could refer an employee to Health Advocate for help…
Discussing appeal options when coverage is denied
Determining if a benefit was applied correctly for physical therapy
Resolving a claim issue when a preventive service was processed as “condition- related” care
Prescription drug questions and benefits for specialty drugs
Understanding doctor’s instructions
Determining coverage when treatment is considered experimental
Employee calls
Your Organization
Your team is able
to assist
Escalated case –
Your service team member calls Health Advocate
or refers employee to Health Advocate

9. Employee still confused or has other questions – calls Health Advocate
Examples of when an employee might need to speak to someone live and calls Health Advocate…
Unsure of what type of doctor to see based on their condition
Went to an urgent care center, but now needs to find a specialist for follow- up care
Needs help with Medicare issues for an ailing mother
Unsure if doctor can perform outpatient procedure at a lower- cost facility
Needs assistance finding an art class for a child with a disability
Found doctor, but not sure she has an appointment available
Needs information on doctor/hospital experience with procedure
Employee uses
Digital
Platform
Employee finds
answer online
Employee still confused or
has other questions – calls
Health Advocate

10. Why Health Advocate?
Health Advocate is an independent and confidential resource that people trust to help resolve their healthcare, insurance and benefits questions and concerns.
Health Advocate’s program is available to the employee, their spouse/partner, dependents, parents and parents-in-law, regardless of their medical insurance carrier.
When positioned as the single phone number to call for benefit issues, Health Advocate’s Benefits Gateway service has increased utilization in other benefit programs by 20% to 50% by recognizing the employee’s need and warm-transferring the contact to another program or vendor when appropriate.
When provided with access to medical and pharmacy claims data in our Empowered Health program, Health Advocate has annually closed up to 50% of the gaps in care present in a population.