MMC Benefits Handbook
Services Provided
A Personal Health Advocate will:
- Assist you in finding medical/vision/dental providers (in or out- of -network) anywhere in the country
- Explain diagnoses, tests, treatments and medications that have been recommended by your doctor
- Assist in obtaining pre-authorization and predeterminations for medical or pharmaceutical services
- Schedule, or attempt to expedite appointments with high-demand specialists
- Locate services that are not covered by your health plan or attempt to find lower cost alternatives
- Coordinate home care equipment following discharge from the hospital and/or answer questions and recommendations by hospital discharge planners
- Coordinate and make arrangements for diagnostic tests
- Assist in estimating costs for common medical services and procedures
- Assist in claim resolution, including:
- Uncovering charges incorrectly applied to your deductible
- Resolving questions about whether services are condition-specific or related to preventative care
- Resolving incorrect plan procedure interpretations, such as emergency room claims denied for a lack of pre-certification
- Providing payers with additional information required to correctly pay a claim or apply a benefit
- Resolving coordination of benefits disputes between multiple providers
- Resolving errors in the application of deductibles and co-payments
- Providing the correct insurance information to the provider for coordination of benefits between dental, medical and other healthcare providers
- Facilitate transfer of medical records and reports prior to scheduled appointment with new provider
- Assist with eldercare and caregiver services including:
- Finding in-home care, adult day care, assisted living, long-term care
- Researching transportation to appointments
- Coordinating care with multiple providers
- Assist in applications and coordination of benefits for individual coverage options including Medicaid, Medicare or other individual policies
- Assist in finding services that may not be covered by a health plan, i.e. private duty nursing, group home for individuals with special needs, home health care, etc.
- Help prepare you for visits with physicians and other providers, including formulating questions to ask a physician during a visit
- Assist you in finding a physician for a second opinion if you would like to consult with another medical professional for verification of original diagnosis or treatment recommendation. Normally applied medical costs will be associated with any resulting physician visits.
Do I have to use this program?