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Advocates Who Help You Negotiate Health Care


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The next time a doctor's office says you have to wait six months for an appointment, or your insurance company gives you the runaround on a big claim, check your corporate benefits plan. You might find you're eligible for a new perk designed to alleviate the stress of dealing with an infuriating health-care system.

In 2008, more than 3,000 employers, including Home Depot (HD), Bertelsmann, EarthLink (ELNK), TIAA-CREF, and Jones Apparel Group (JNY), will offer employees free access to an independent health advocate.

Advocates, who have long been available for hire by individuals, decode cryptic insurance statements, provide elder care and mental health guidance, and negotiate fees. They can cut through an insurer's red tape to settle a claim or get a procedure covered, and even score appointments with hard-to-reach physicians. Such intermediaries can pull strings with doctors, hospitals, and insurers by forging relationships with key contacts. What also gives advocates—who are typically former nurses, doctors, and other health professionals—an edge with providers is that they can speak as peers.

Advocates fill a niche as employers push more health costs onto workers, through high-deductible insurance plans or steeper premiums. But skeptics point out that an advocate's first allegiance is to the employer who is paying for the service. "Everyone needs to be reminded that advocates representing companies will ultimately be sympathetic to the company's position and benefits—or denial of benefits," says Nancy Davenport-Ennis, president of the National Patient Advocate Foundation, a patient-rights group.

Marty Rosen, chief marketing officer at Health Advocate in Plymouth Meeting, Pa., the largest employer-paid advocacy service in the U.S., counters that advocates are "ecumenical" with the primary goal of keeping people healthy. "Although employers pay for our service, this does not influence what we do," Rosen says. "We have generated significant medical cost savings for employees as well as employers."

Health Advocate was co-founded in 2001 by Rosen and Abbie Leibowitz, former Aetna (AET) insurance executives. Right now it doesn't have much competition. Small players such as Touchpoint 24/7 focus on elder care and other niche areas. Big insurers, such as CIGNA (CI), are stepping up their own advocacy services, although you might rightly wonder whether a service owned by an insurance company can be impartial. "When you get an outside advocate, you are getting a more objective point of view," says Raina Sedhom, regional leader of the labor, compensation, and employee benefits group at BDO Seidman in New York.

In addition to solving problems, advocates should help workers get more from their medical providers. "They are arming employees with the right questions, pointing them to research and clinical trials, and suggesting potential alternatives to ask doctors about," says Randy Abbott, a senior benefits consultant at Watson Wyatt Worldwide (WW) in Boston.

WELCOME OUTSIDERS

With privacy a concern for all sides, advocates can create some much needed separation between workers and human resources departments. "With an advocate, employees get the help they need without us having a lot of the personal information that, quite frankly, we don't want to have," says Cheryl Melinchak, principal human resources consultant at Westinghouse Electric. The Monroeville (Pa.) nuclear energy company started offering Health Advocate's services in 2002, and the program currently covers 5,800 U.S. employees.

Perhaps the biggest reason companies are offering this benefit is that it can help keep workers focused on their jobs, rather than navigating an insurer's voice answering system or "Googling everything under the sun about a medical condition," Watson Wyatt's Abbott says. Depending on the complexity of the case, problems can be resolved in a few hours or a few weeks.

Advocate programs, typically paid in full by the employer, cost $2 to $3 per employee per month. In addition to spouses and children, coverage extends to parents and in-laws, even if they use a different insurance plan. At Westinghouse, advocates are available to retirees, too.

The big hurdle is getting the word out. At Kindred Healthcare (KND), based in Louisville, it has been a challenge to educate employees—and they work in health care. Kindred, which operates long-term care hospitals and rehabilitation centers, launched a program through Health Advocate in August, 2004, so the message wouldn't get lost in enrollment materials that come out in the fall. Since then, it has bombarded workers with posters and flyers. "You can't communicate this once," says Andrea Romisher, Kindred's director of benefits, noting usage is picking up. Despite such publicity blasts, just 5% to 7% of those eligible for an advocate service use it, says Susan Connolly, a worldwide partner with Mercer Human Resource Consulting in Boston.

Jeanne Leslie, an executive assistant at CNA, a Washington-area think tank, is one satisfied customer. Two years ago, she constantly felt faint and underwent a barrage of tests. Her primary-care doctor suggested a visit with a cardiologist, but she was told it would take a month to see the specialist. So she called CNA's advocate hotline and, within an hour, the nurse assigned to her case got her an appointment with the cardiologist—for the next day.

Corrections and Clarifications

In "Advocates who help you negotiate health care" (Personal Business, Oct. 22), Andrea Romisher's title was incorrect. She is vice-president for benefits and compensation at Kindred Healthcare.

By Lauren Young


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