Workspan Discusses

"How Health Care Claims Advocacy Can Improve Productivity" 

"Offering access to a  health-care claims advocacy service is a relatively small investment that can pay off significantly in terms of keeping employees engaged and adding further perceived value to their total rewards package."  They note in their article:" How Health Care Claims Advocacy Can Improve Productivity", that "resolving health claims can be a daunting and time-consuming process for employees, as they struggle to advocate for themselves with their health insurers and providers.  So, too, for the HR departments whose limited resources make such advocacy on behalf of their employees equally difficult."

This same industry source acknowledges that "Success in providing claims advocacy services requires that representatives be well-versed in the nuances of the health-care-claims system."  They state that by "entrusting the resolution of stalled, underpaid, or denied claims, along with a range of other health benefits services and issues, to a dedicated team of third party specialists, employees are able to navigate the increasingly complex health care system with greater ease."

The good news, noted by Workspan in their article, is  "this  ( claims advocacy) helps (employees) remain productive and improves their benefits experience while HR professionals can focus more on strategic issues and less on administrative processes and individual disputes.  A win-win for employer and employee"

This excellent and in-depth article , written for Workspan by Rich VanThournout and Sander Domaszewicz, of Mercer,  notes that the percentage the employee is contributing to his/her health care benefits is increasing  and that "employers are asking employees to become more accountable for their health status, health choices, and use of health services."  The authors propose that "one of the many benefits of a health care claims advocacy service is that it provides a balance to this requirement for increased responsibility (by) delivering additional support when employees need it the most.  It sends an empowering message that an employee doesn't have to "go it completely alone" when navigating the health care system."


Quick Facts Concerning New Health Care Laws:

  • Extended Eligibility :Since the March 2010 passage of the Patient Protection and Affordable Care Act (PPACA) U.S. employers have felt its effects, with an average 2 percent increase in enrollment as of July 2011.  This is attributed primarily to the extended eligibility for dependent coverage to employees' children up to age 26.  (this according to a survey by HR consultancy Mercer and released in August 2011.


Covering Part-Time Workers:

  • Part Time Status: The new ruling, that takes effecct January 1, 2014, is that employers must offer "affordable" coverage to all employees working an average of 30 hours or more a week in a month (or else be subjected to penalties) may be news to some small businesses.  If you are an employer utilizing a number of "part time" workers, it is important that you review your position with an HR legal professional to ensure that you are able to develop your strategy and budgeting options based on sound information.


Affordable Care Act and Preexisting Conditions Insurance Program:

If you are interested in understanding the Affordable Care Act and other state based health initatives, visit the West Virginians for Affordable Health Care at

Another excellent Link provides information on Preexisting Conditions Insurance and you will find that at www.PCIP.Gov