Efficient and Dependable
The Personal Health Advocate (PHA) is a trained professional, typically a registered nurse, supported by medical directors and benefits and claims specialists, who understands the intricacies of the healthcare system and how to navigate through it. As soon as a member contacts us, they establish a relationship with a PHA who stays with them through to the resolution of the problem. Our PHAs demonstrate a commitment to service excellence, have strong problem-solving skills, and support members as they seek healthcare services and interact with providers and insurers. Personal Health Advocates handle claims, benefits, grievances, paperwork and other issues. Health Advocate can be accessed 24/7. Our normal business hours are Monday–Friday between 8 am and 9 pm Eastern Time. After hours and during weekends, staff is available for assistance with issues that need to be addressed during non-business hours.
Health Advocate is always at your side
Clinical Support Services
The Personal Health Advocate helps members coordinate care among physicians and medical institutions in various ways:
•Helping members understand tests, treatments and medications recommended or prescribed by their physicians
•Assisting members through complex medical conditions
•Facilitating the transfer of medical records, X-rays and lab results prior to a scheduled
appointment with a new physician
•Arranging for home-care equipment following discharge from the hospital
•Facilitating a review of test results with another physician for confirmation of a diagnosis
•Coordinating and making arrangements for diagnostic tests
•Coordinating care for a member with complicated medical issues
•Consolidating a multiple-day testing schedule for special needs members
•Arranging for a member to be evaluated for participation in a clinical trial
•Coordinating hospice and other services for terminally ill members
•Fostering communication and coordinating benefits between physicians and insurance companies
Advocates of Excellence
Helps members with rare, serious or complex medical conditions identify top medical
institutions, critical illness providers and specialized medical programs across the
country. Our Personal Health Advocates will schedule appointments and research
transportation and lodging when necessary.
Helps members identify primary and specialist physicians, hospitals, dentists and related healthcare providers. Our first focus is on network relationships to help members use their
benefits to their best advantage.
The Personal Health Advocate can provide members with assistance on prescription drug issues including formulary and benefit questions.
•Helping members better understand multi-tiered pharmacy benefit plans
•Providing information for renewing prescriptions
•Providing information on generic drugs
•Locating lower-cost sources for prescription drugs that are not covered by their health plan
•Assisting members in obtaining mail-order prescriptions
•Resolving questions between members and pharmacies regarding the amount of product
requested and the amount dispensed