Most employees haven’t had the benefit of working with a healthcare navigator to solve insurance questions. When employees don’t know where to turn for answers, they often solicit the help of their HR team to help them navigate the ins and outs of their healthcare benefits.
Healthcare navigators have a deep level of expertise in everything from claims to referrals (and just about every issue in between), helping to remove the administrative burden of tracking down answers from both employees and employers.
Here are three of the most common questions employees surface about their healthcare and how HR teams can rely on healthcare navigators to help them find the solutions they’re looking for:
- “Can you help me find a provider?”
Anyone can do a provider search online, but healthcare navigators customize results that are tailored specifically to an employee’s care needs and personal preferences. Rather than just curating a list of providers covered by a particular insurance plan, healthcare navigators will do all of the legwork to confirm that a provider is in-network, is accepting new patients, and is accepting new patients in a reasonable timeframe. “We do that administrative work so employees don’t need to call twenty different offices,” said Jessica Green, Director of Member Experience at Eden Health. “We ensure that providers can meet a patient’s clinical needs (whether or not they can do the appropriate diagnostic testing, for example) and that they meet your personal preferences. For example, some patients may be more comfortable seeing a provider who has experience working within the LGBTQ+ community or may need a provider who offers evening hours because their work schedule is demanding. We narrow down those searches so that patients can focus on living their lives.”
- “I have a bill or EOB from my insurance company. How do I know if it’s accurate?”
Clerical errors happen every day and in every industry — including at doctors’ offices and insurance providers. When an employee receives a big or unexpected bill, healthcare navigators can step in to assess the bill or explanation of benefits (EOB) to ensure whether or not it’s accurate based on the employee’s selected healthcare plan. “Our role here is to help employees troubleshoot,” said Green. “If a bill is correct and an employee does owe money, we can help them understand their options, like using an HSA, HRA, or FSA to provide payment or contacting the provider or facility to see if they have a patient payment plan available. If we find that a bill is not correct, we work with the employee’s provider and insurance company to help resolve the claim issue on their behalf. We keep the employee updated every step of the way — we always want them to know what’s coming next and when to expect it.”
- “Do I have coverage for this?”
Sometimes, employees will have questions about procedures or treatments that are considered an advanced benefit. For example, some employers offer coverage for fertility or genetic counseling, while others do not. Sometimes, patients need to get a less expensive test before the next test is covered. Some employees may have questions about alternative therapies, like equine therapy. “If an employee has questions about an advanced benefit, we’ll work with the insurance company to see if they have coverage for that particular service,” said Green. For many employees, having an external resource outside of their HR team for these more obscure questions can be a relief, especially when their questions may involve sensitive aspects of healthcare, like fertility or substance abuse.
To learn more about how Eden can remove administrative burdens like these from HR’s plate, request a demo today.