Coverage

The Personal Health Advocate is a trained professional, typically a Registered Nurse, who understands the intricacies of the healthcare system and how to navigate through it.  Our Personal Health Advocates 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.  Each case is handled with utmost confidentiality.

Health Advocate can be accessed 24/7.  Normal business hours are Monday-Friday between 8:00 am and 7:00 pm.  After hours and on the weekends, on-call staff is available for assistance with issues that need to be addressed during non-business work hours.

Summary of Coverage:
Complete coverage brochure

Services	Details
Clinical Support Services Care Coordination Advocates of Excellence Physician Locator Rx Advocate	Help members understand tests, treatments and medications Facilitating transfer of medical records, x-rays, lab results prior to appointment with a new physician Arranging for home-care equipment following hospital discharge Coordinating tests, second opinions Coordinating care for a member with complicated medical issues Consolidating a multiple-day testing schedule for members with special needs Arranging Hospice and other services for terminally ill patients Helps members with rare, serious or complex conditions to identify to medical institutions, critical illness providers and specialized programs across the country Help with prescription drug issues
Administrative Support Services Claims & Billing Assistance Fee Negotiation Appeals Advice Coverage Advantage	Help sort out and solve claims and related paperwork problems Help with coverage issues and understanding the coding and payment rules that apply to their circumstances Research out-of-pocket responsibilities Correct balance billing problems Coordination of benefits between dental, medical, workers compensation and disability carriers When necessary, Health Advocate can attempt to negotiate fees with healthcare providers to lower the member's out-of-pocket costs Help members through the review and appeals process if there are questions about coverage
Healthcare Coaching	Provide members with the information they need to become more active in the management of their health  Help prepare members for their visits with healthcare providers
Information & Service Support CareQuest MD Direct Complementary and Alternative Medicine Mind Matters Healthy Wheels Senior Care Navigator Wellness	Help locate and make arrangements for members' special services needs (locating homemaker, adult day care and rehabilitation services, inpatient private duty nursing, group homes, home health aides) Help completing applications for Medicaid and Medicare Provide members with access to experts for consultations and second opinions Help identify and coordinate a range of wellness services including accupuncture, chiropractic care, massage therapy Help members find an appropriate mental health provider to meet their specific needs Help arrange transportation services to support members' healthcare needs Services geared toward seniors:  alternative healthcare facilities, obtaining coverage for medical supplies, providing information on adult day care programs, coordinating with Medicare or Medicaid Help locating providers for weight management, stress management, and other wellness providers
Complete coverage brochure Health Advocate does not replace health insurance coverage, provide medical care or recommend treatment.

Eligibility

All regular employees of Davidson College are eligible for this benefit.

Cost

There is no cost to the employee for this benefit.

Forms, Links and Vendor Information

• Complete coverage brochure
• Website

Plan Administrator

Health Advocate

Member Services

866-695-8622
610-941-4200 (fax)
email to answers@healthadvocate.com

Last Update 10/22/08