As we all know, healthcare is an increasingly complex and often confusing world.  BenefiTree is committed to strong and effective advocacy on behalf of employers and individuals as needs dictate when this complexity requires trusted, knowledgeable assistance.  Interventions can range from an appropriately placed follow up email to an in depth analysis and issue shepherding through the related bureaucracies. To make this happen, specialists are available immediately and virtually 24/7 to meet client’s needs and partner in a variety of issues requiring expertise, discretion, and sensitivity leading to effective resolution and results.

Our advocacy is always carefully balanced with the organization’s business needs and objectives as directed by leadership.  Additionally, BenefiTree negotiates with insurance carriers to provide escalated issue support via expanded call center hours to assist with urgent matters.

On behalf of employers in this regard, BenefiTree is prepared to analyze and evaluate employee benefit programs, work with service providers and insurance companies to monitor and evaluate performance, identify cost savings and administrative enhancement opportunities.  This may mean that we:

• Solicit bids from insurance companies, service providers, prescription drug companies, utilization review and cost containment providers, and administrators and stop loss carriers
• Secure information and analyze large claims incurred, prognosis, underwriting threshold for assumption, lasering.
• Determine plan design parameter (plan type, deductibles, co-payments, prescription drug formularies).
• Collect, format and transmit EE data to underwriters.
• Solicit insurance carrier bids, analyze contract provisions, restrictions, limitations.
• Evaluate proposed benefit plans submitted by various insurance carriers and administrators.
• Evaluate Preferred Provider HMO contracts, primary and reciprocal PPO/HMO arrangements for out or area providers.
• Develop and deliver presentation of plan recommendations, review alternative plan designs.
• Assist in development and presentation of plan changes to employees, leadership, and Board members.
• Participate in the on-site communications and enrollment of eligible employees
• Develop and deliver recommended phases of Plan Designs with phased approaches to additional cost savings features, including consumer-driven plans.
• Establish cost containment process and implementation, monitored with agreed critical trigger points to control benefit costs if self-funded.
• Participate in meetings to provide complete analysis and performance results for insurance programs.
• Secure bids for alternative third party administrator or service provider for the Flexible Benefit Plan and/or health savings accounts (HRS/HSA) as directed if self-funded.
• Facilitate and coordinate implementation of the tax-favored health accounts as deemed appropriate.
• Recommend, implement, and service various voluntary products consistent with the organizational objectives and not duplicative or inconsistent with other employer-sponsored benefits.
• Serve as a resource for escalated service issues

With regard to a serious personal injury, a summary of a recent actual client situation demonstrates how this can unfold with our assistance:

A member of a medical plan we serve was involved in a catastrophic car accident late in the evening.  Unconscious, she was taken to a hospital with severe injuries, a family member was called.  During that time, a family member called the Employer to ask what to do to get critical care treatment for her.  They were having difficulty contacting the insurance company’s department which would handle the situation.  It was later determined that the family member was calling the wrong number.  The Employer contacted BenefiTree.  Before other family members had arrived a representative from BenefiTree had made contact with the insurance company’s critical care unit, within less than 5 minutes a Case Manager was assigned and soon our representative was on the scene at the hospital to ensure all approvals were obtained for whatever was deemed appropriate by the various providers.   Within 20 minutes precertification was received for surgery to the skull, spine and hand.  The outcome was good.  The BenefiTree representative stayed the night with the family through each surgery. During the next few months, Cosmetic Surgery, Physical Therapy and additional surgery was required, all of which was handled efficiently through our coordination with various providers and the insurance company.

A spreadsheet analysis was maintained for several months, at no charge to the Employer or Employee, outlining all providers, billed cost, discounted costs, payments from insurance company, and out of pocket expense of the insured.  When the employee had reached the out of pocket maximum required, BenefiTree contacted the claims manager who worked diligently with our team to reconcile claims and approve 100% coverage for the balance of these significant expenses for the additional months of treatment.  As sometimes occurs, medical providers inadvertently continue to bill the patient.  These bills were transmitted to our team who arranged for total resolution of the issues.