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AmWINS Group Benefits launches employees’ “Guardian Angel” in new Member Advocacy Program
Warwick, RI – Navigating the maze of health care claims,
network referrals and deductibles requires specialized training and
often leaves employees, their families and human resources experts
feeling ill. AmWINS Group Benefits, a leading distributor of
wholesale retiree and employee group health benefits and
professional services, today launches a Member Advocacy Program to
supplement other health insurance plans.
The new program is designed to handle the sometimes overwhelming paperwork and processes resulting from health care claims. The Member Advocacy Program provides individuals and their families with a personal advocate team to coordinate, research and support their needs.
The Member Advocacy Program has three significant features, which include:
• Member Advocacy: Provides support in situations when insurance companies or plan administrators are unable to resolve issues on behalf of the employees or their dependents
• Member Outreach: Proactive outreach is made to members that have multiple health care claims or continuous contact with the insurance companies or health plan administrators
• Benefit Exception Determination: Within defined limits and coverages, the Member Advocacy Program determines benefit exceptions and/or benefit determinations when the plan documents fail to provide clarity or when acting in the best interests of the plan or member. Additionally, the program ensures uniformity in the application of future benefit administration
“Ill employees, their families and their employers should be concerned with feeling better, rather than serving as the middle-man with their health insurance company,” said Sam Fleet, AmWINS Group Benefits President & CEO. “It’s in everyone’s best interest to have a specially-trained expert in their corner to settle claims and keep the paperwork moving.”
Employers who leverage the Member Advocacy Program will benefit by:
• Minimizing or eliminating exposure to HIPAA related privacy issues
• Achieving quick resolution of complex/complicated health care claims
• Realizing real cost and time savings as both employee claimants and human resources personnel are relieved of managing the health care claimssettlement process
• Maximizing the effectiveness of health insurance plans by analyzing issues and reports provided by program
• Enhancing the quality of care provided to employees
“Member Advocacy Program advocates must meet specific criteria, including at least a decade of specialized training on how to mediate claims and advocate for patients,” said Mike McCabe, President of WEB-TPA, an operating company within AmWINS Group Benefits. “Who wouldn’t want the best in the industry serving as their guardian angel of health care? These days, we could all use one.”
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The new program is designed to handle the sometimes overwhelming paperwork and processes resulting from health care claims. The Member Advocacy Program provides individuals and their families with a personal advocate team to coordinate, research and support their needs.
The Member Advocacy Program has three significant features, which include:
• Member Advocacy: Provides support in situations when insurance companies or plan administrators are unable to resolve issues on behalf of the employees or their dependents
• Member Outreach: Proactive outreach is made to members that have multiple health care claims or continuous contact with the insurance companies or health plan administrators
• Benefit Exception Determination: Within defined limits and coverages, the Member Advocacy Program determines benefit exceptions and/or benefit determinations when the plan documents fail to provide clarity or when acting in the best interests of the plan or member. Additionally, the program ensures uniformity in the application of future benefit administration
“Ill employees, their families and their employers should be concerned with feeling better, rather than serving as the middle-man with their health insurance company,” said Sam Fleet, AmWINS Group Benefits President & CEO. “It’s in everyone’s best interest to have a specially-trained expert in their corner to settle claims and keep the paperwork moving.”
Employers who leverage the Member Advocacy Program will benefit by:
• Minimizing or eliminating exposure to HIPAA related privacy issues
• Achieving quick resolution of complex/complicated health care claims
• Realizing real cost and time savings as both employee claimants and human resources personnel are relieved of managing the health care claimssettlement process
• Maximizing the effectiveness of health insurance plans by analyzing issues and reports provided by program
• Enhancing the quality of care provided to employees
“Member Advocacy Program advocates must meet specific criteria, including at least a decade of specialized training on how to mediate claims and advocate for patients,” said Mike McCabe, President of WEB-TPA, an operating company within AmWINS Group Benefits. “Who wouldn’t want the best in the industry serving as their guardian angel of health care? These days, we could all use one.”
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