For HR professionals, the open enrollment period means extra responsibilities as you answer employee questions and help workers select plans. Eden Health takes this burden off of HR teams with our Clinical Associates, who are trained to support employees throughout the process. In this blog series, we check in with some of these insurance experts and ask them why they love helping patients navigate their benefits.
What does a Clinical Associate do?
To improve health outcomes, we help patients navigate their insurance and understand how their benefits apply to their different health issues.
Can you give an example of how you’ve helped a customer recently?
A patient just got a specialist’s bill for $7000 and they were pretty confused as to how they got that bill, since they had insurance. I found out the specialist’s billing office had actually sent the bill to the patient prior to the insurance kicking in, which would remove about $6000 off that amount.
I was able to reiterate to the patient, “Don’t worry. This was an error on the side of the office sending you that bill prior to all of your insurance kicking in. You’re going to get a bill explaining the actual payment you owe.” He was pretty happy he did not have to pay that $7000 bill.
How do Clinical Associates fit into Eden’s concept of integrated health?
A lot of times healthcare is very fragmented and having to jump to multiple different physicians can lead to a difficult time for the patient. So I think it’s really amazing to have this very central care unit. At Eden, we know the different physicians you’re going to, and we have a lot of your medical information. And it’s great to have a central resource like a benefits navigator where you can go to ask your questions.
As a Clinical Associate, how are you helping patients with issues related to COVID-19?
More and more companies and academic organizations are coming up with rapid COVID-19 testing methods. So a lot of patients are trying to figure out, “Are there places near me that I could get a rapid test? My mother’s coming in two days. I really need to get this test before she comes.” So that’s a large part of what we do.
Do you think that you help patients get better use out of their health coverage?
In general, people don’t know much about health insurance. Even I didn’t know much about it before getting into the health insurance realm. A large part of what we do is educate the patient so that in the future, they’ll know what’s going on when they see these bills or confusing words like “deductibles” and “coinsurance.” We want to be a resource and answer questions, but that doesn’t mean they shouldn’t also be educated in this field. This is knowledge that they’re going to need throughout their lives. I think Eden is definitely very effective in terms of empowering patients in that way.
How are you able to help HR managers and their teams?
HR has a fairly encompassing role in creating an environment for their workforce to succeed. But for employees, the health insurance burden and having all these different costs can create stressors that distract from work. By helping employees navigate care and insurance, we help reduce those stressors so they can be more effective and productive employees. So for us, helping with health insurance navigation can lessen some of HR’s pain points.
Do you think it’s better for patients to get answers from human benefits navigators like you rather than an automated online portal?
In the past, I’ve used those online portals and most of the time I felt pretty frustrated because they didn’t really understand what I was trying to ask or what I was going through. With an automated service, you’re not really getting that sense of engagement where your questions are being answered, where you feel like you’re actually able to have that back and forth discussion.
Benefits navigators are able to really engage on a wider level to explore different options with the patient and create a discourse that an online portal doesn’t make possible. In general, humans are very interpersonal creatures. As Clinical Associates, we really enjoy fostering that relationship with others.
How does it make you feel when you can help patients resolve issues?
It makes me feel great! They’re always so appreciative, saying, “thank you so much. I really needed this.” Or “I was struggling really hard and you guys were able to really provide me the answers I needed.” So it feels good to know you’re really making a positive impact on someone.
Health issues are not easy to deal with, and it’s emotional for everyone going through that. I like being able to provide some sort of solace or mitigate any type of tension for employees, and ease their healthcare issues or payment issues or any burdens they have.
I especially like being able to help them in a sustainable long term fashion with actual learning, rather than the quick fix of, “someone told me to do this and I’m okay for now.”
How is it working at Eden Health?
I’m really excited to be here. Everyone is super passionate about the mission, this whole idea of integrated care. And I really like being able to go above and beyond to help the patient. Just now I was on a call for over two hours with one of my coworkers, trying to figure out this insurance question. It just shows how much we want to help and how much we really value the patients and their outcomes.
For tips on open enrollment from our Clinical Associates, download our free ebook Navigating the Benefits Maze.