Health Advocate
Encyclopedia
Health Advocate, Inc. is a national health advocacy
, patient advocacy
and assistance company, serving more than 6,000 clients and 18 million people and offering a spectrum of services to help employers, employees and consumers navigate the healthcare system and facilitate members’ interactions with insurers and providers. The privately-held company was founded in 2001 by former Aetna
executives and is headquartered in Plymouth Meeting, Pennsylvania
. The company employs registered nurses, medical directors and benefits specialists who address a range of health care
and health insurance
issues. Personal Health Advocates work one-on-one with members to help them navigate the complicated world of health insurance and medical care. For example, Personal Health Advocates can help members locate providers, address errors on medical bills, answer questions about covergae denials and assist with insurance appeals.
The company's complementary solutions include Wellness Advocate, Benefits Gateway, EAP and Worklife, Health Information Dashboards, Pricing Decision Support and HR solutions. The company also offers a direct-to-consumer advocacy service, called Health Proponent to individuals who are not part of groups.
For example: Helping members understand tests, treatments, and medications recommended or prescribed by physicians, facilitating the transfer of medical records, X-rays, and lab results before a scheduled appointment with a new physician, arranging for home-care equipment after discharge from a hospital, facilitating review of test results with another physician for confirmation of diagnosis, consolidating a multiple-day testing schedule for members with special needs, arranging hospice and other services for the terminally ill, facilitating transfer from a community hospital to a tertiary care facility.
For example: Researching a member’s outstanding out-of-pocket responsibilities and resolving errors with providers and/or the member’s health plan, correcting balance-billing problems, correcting charges incorrectly applied to the member’s deductible, resolving eligibility problems and benefit and claim denials, coordinating benefits between dental, medical, worker’s compensation, and disability carriers, assuring correct application of provider network status, correcting errors in processing of “blind” network provider discounts, resolving coordination-of-benefits disputes between carriers, satisfying plan requests for copies of referrals, providing correct member insurance information to providers.
COMPLEMENTARY SOLUTIONS
Those whose employers do not offer the service can purchase it from Health Advocate's direct-to-consumer arm Health Proponent.
Health Advocacy
Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve...
, patient advocacy
Patient advocacy
A Patient Advocate acts as a support structure and if legally contracted to do so may act as a liaison between a patient and their Health Care Provider. Most health care professionals see themselves as advocates for their patients, however their time and scope are limited by their job function...
and assistance company, serving more than 6,000 clients and 18 million people and offering a spectrum of services to help employers, employees and consumers navigate the healthcare system and facilitate members’ interactions with insurers and providers. The privately-held company was founded in 2001 by former Aetna
Aetna
Aetna, Inc. is an American health insurance company, providing a range of traditional and consumer directed health care insurance products and related services, including medical, pharmaceutical, dental, behavioral health, group life, long-term care, and disability plans, and medical management...
executives and is headquartered in Plymouth Meeting, Pennsylvania
Plymouth Meeting, Pennsylvania
Plymouth Meeting is a census-designated place in the Montgomery County, Pennsylvania, United States. It is the northern terminus of the "Blue Route" and the southern terminus of the Pennsylvania Turnpike Northeast Extension . The population was 6,177 at the 2010 census...
. The company employs registered nurses, medical directors and benefits specialists who address a range of health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
and health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
issues. Personal Health Advocates work one-on-one with members to help them navigate the complicated world of health insurance and medical care. For example, Personal Health Advocates can help members locate providers, address errors on medical bills, answer questions about covergae denials and assist with insurance appeals.
The company's complementary solutions include Wellness Advocate, Benefits Gateway, EAP and Worklife, Health Information Dashboards, Pricing Decision Support and HR solutions. The company also offers a direct-to-consumer advocacy service, called Health Proponent to individuals who are not part of groups.
Products and Services
CORE ADVOCACY- Clinical Assistance – specialized medical and pharmaceutical advice and research.
For example: Helping members understand tests, treatments, and medications recommended or prescribed by physicians, facilitating the transfer of medical records, X-rays, and lab results before a scheduled appointment with a new physician, arranging for home-care equipment after discharge from a hospital, facilitating review of test results with another physician for confirmation of diagnosis, consolidating a multiple-day testing schedule for members with special needs, arranging hospice and other services for the terminally ill, facilitating transfer from a community hospital to a tertiary care facility.
- Administrative Assistance - resolving claims and benefits issues, and help finding assistance outside the health plan.
For example: Researching a member’s outstanding out-of-pocket responsibilities and resolving errors with providers and/or the member’s health plan, correcting balance-billing problems, correcting charges incorrectly applied to the member’s deductible, resolving eligibility problems and benefit and claim denials, coordinating benefits between dental, medical, worker’s compensation, and disability carriers, assuring correct application of provider network status, correcting errors in processing of “blind” network provider discounts, resolving coordination-of-benefits disputes between carriers, satisfying plan requests for copies of referrals, providing correct member insurance information to providers.
COMPLEMENTARY SOLUTIONS
- Wellness Advocate - provides employers and other plan sponsors with a broad array of wellness solutions that help employees lose weight, get fit and make other healthy lifestyle changes. The program is designed to reduce risks of diseases, prompt employees to take an active role in their healthcare and make informed decisions about their healthcare. The program features access to live Wellness Coaches coupled with comprehensive, up-to-date health and wellness information.
- Employee Assistance Program (EAP)/ WorkLife - counseling and work/life services provide in-depth help to resolve healthcare and insurance-related issues.
- Enrollment Advocate - designed to help answer employees’ questions about health plan options and features during an organization’s annual open enrollment period. This ensures that enrollment runs smoothly and effortlessly.
- Medical Bill Saver - help negotaiting discounts on non-covered or out-of-network medical claims.
- Benefits Gateway and Health Information Dashboards - offer a personalized, integrated service that gets employees to the right benefit, quickly and efficiently, through a single toll-free number. The dashboards then use algorithms to interpret data from multiple sources and provide a snapshot of member information about benefits use and specific health indicators.
Who is Covered?
Employers generally offer the service to their employees as an added benefit and extension to their healthcare insurance plans. The employee’s immediate family is also covered. This includes spouses, dependent children, parents and parents-in-law. According to one client, Wawa Food Market's director of compensation and benefits, "As an employer there's a limit to what we can do for our employees. For us it made sense to have this service available, where our associates can reach out to somebody who knows the ins and outs of the health-care business." The company's services are available 24 hours a day, 7 days a week.Those whose employers do not offer the service can purchase it from Health Advocate's direct-to-consumer arm Health Proponent.
Awards
- Ranked 114 in Inc. (magazine)Inc. (magazine)Inc. magazine, founded in 1979 and based in New York City, is a monthly publication focused on growing companies. The magazine publishes an annual list of the 500 fastest-growing private companies in the U.S., the "Inc...
500: America’s Fastest Growing Private Companies: 2007 - Ranked 9 in Top Inc. (magazine)Inc. (magazine)Inc. magazine, founded in 1979 and based in New York City, is a monthly publication focused on growing companies. The magazine publishes an annual list of the 500 fastest-growing private companies in the U.S., the "Inc...
5000 Companies by Industry – Health: 2007 - Ranked 3 in Top Inc. (magazine)Inc. (magazine)Inc. magazine, founded in 1979 and based in New York City, is a monthly publication focused on growing companies. The magazine publishes an annual list of the 500 fastest-growing private companies in the U.S., the "Inc...
5,000 Companies by Metro Region—Philadelphia-Camden-Wilmington, PA-NJ-DE: 2007 - Inc. (magazine)Inc. (magazine)Inc. magazine, founded in 1979 and based in New York City, is a monthly publication focused on growing companies. The magazine publishes an annual list of the 500 fastest-growing private companies in the U.S., the "Inc...
500: America’s Fastest Growing Private Companies: 2008 - Inc. (magazine)Inc. (magazine)Inc. magazine, founded in 1979 and based in New York City, is a monthly publication focused on growing companies. The magazine publishes an annual list of the 500 fastest-growing private companies in the U.S., the "Inc...
500: America’s Fastest Growing Private Companies: 2009 - Ranked 5th in the Philadelphia 100, Philadelphia Business JournalPhiladelphia Business JournalThe Philadelphia Business Journal is a weekly business-oriented newspaper published in Philadelphia, Pennsylvania. It is published by the American City Business Journals....
/ Wharton Small Business Center, 2006 - Ranked 19th in the Philadelphia 100, Philadelphia Business JournalPhiladelphia Business JournalThe Philadelphia Business Journal is a weekly business-oriented newspaper published in Philadelphia, Pennsylvania. It is published by the American City Business Journals....
/ Wharton Small Business Center,2007 - Ranked 60th in the Philadelphia 100, Philadelphia Business JournalPhiladelphia Business JournalThe Philadelphia Business Journal is a weekly business-oriented newspaper published in Philadelphia, Pennsylvania. It is published by the American City Business Journals....
/ Wharton Small Business Center,2009 - Top 20 Best Places to Work, Philadelphia Magazine, 2007
- CFO of the Year, Philadelphia Business JournalPhiladelphia Business JournalThe Philadelphia Business Journal is a weekly business-oriented newspaper published in Philadelphia, Pennsylvania. It is published by the American City Business Journals....
, 2008 Finalist - CFO of the Year, Philadelphia Business JournalPhiladelphia Business JournalThe Philadelphia Business Journal is a weekly business-oriented newspaper published in Philadelphia, Pennsylvania. It is published by the American City Business Journals....
, 2009 Winner - Philadelphia Business JournalPhiladelphia Business JournalThe Philadelphia Business Journal is a weekly business-oriented newspaper published in Philadelphia, Pennsylvania. It is published by the American City Business Journals....
- Best Places to Work 2009 Winner - Eastern Technology Council - Life Sciences CEO of the Year 2009 - Mike Cardillo Winner
Published Works
- Rosen, Martin B. & Leibowitz, Abbie. “Health Advocacy Programs Help Employers and Employees Navigate Health Care and Insurance Systems.” Employee Benefit Plan Review Volume 57, Number 4, October 2002
- Rosen, Martin B. & Leibowitz, Abbie. “Health Advocacy Helps Employers and Employees Cope with Health Care and Insurance Systems.” HIU Health Insurance Underwriter November 2002
- Leibowitz, M.D., Abbie. “What Do Patient Advocates Do?” National Underwriter Vol. 3, No. 2, December 2003
- Cardillo, Michael & Rosen, Martin. “Benefits, Challenges of Consumer-Driven Healthcare.” Human Capital January/ February 2004
- Rosen, Martin B. & Leibowitz, M.D., Abbie. “Health Advocacy Helps Employers and Employees Cope with Healthcare and Insurance Systems.” Philadelphia SHRM Chapter News February 2004
- Rosen, Martin B. & Leibowitz, M.D., Abbie. “Health Advocacy: Saving Time and Money for Employers and Employees.” Employee Benefits August 2004
- Leibowitz, M.D., Abbie. “Health advocacy: Strategic complement to consumer-directed Healthcare.” Inside HR/NY September 2004
- Leibowitz, M.D., F.A.A.P., Abbie. “The Role of Health Advocacy in Disease Management.” Disease Management Volume 8, Number 3 2005
- Rosen, Martin. “Health Advocacy: A New resource for Employers.” Pension & Benefits Update Vol. 16, No. 3, March/ April 2005
- Rosen, Martin B. “Health Advocacy: Saving Time and Money for Employers and Employees.” The Healthcare Savings Chronicle Volume 3 August 2005
- Martin B. Rosen and Arthur “Abbie” Leibowitz, M.D. coauthored The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed
- Rosen, Martin B. “Simple Ways to Organize Your Older Relatives.” Buttoned Up 6 January 2010
- Rosen, Martin B. “Top 10 Ways to manage Eldercare.” S.I. Parent March 2010
- Chiaro MSW, LSW, Michelle. "The Role of Social Work in Health Advocacy." Social Work Today Newsletter August 2010