A Discussion of Benefit Navigation:

When dealing with an individual who is not yet a member of a coverage plan, but is seeking to determine what his/her family needs in medical care coverage, BeneScope Benefit Navigation is able to provide a framework for personal decision making by discussing options, types of plans available, and the costs inherant in such coverage.  It is important to note that BeneScope, Inc. is not in the business of insurance sales and represents no insurance carrier.  When BeneScope liaisons discuss coverage needs and options with individuals, they are able to speak from a neutral and unbiased position, helping the individual reflect on their specific coverage needs without undue influence from a third party.   

As we work with employees who are already members of an insurance plan, we focus on helping that member to look clearly and realistically at the benefits that are a part of their existing plan. This look at existing coverage empowers the member to determine how best to utilize their plan so that they and their family receives the best health care possible.  This internal look into a member's existing coverage falls under the BeneScope Claims & Benefit Advocacy service.

Often the most important part of a member's relationship with their health insurance carrier is fully understanding what their policy actually covers and what types of actions and/or  steps they (as the policy holder) may need to take to appropriately utilize their benefits to full advantage.  BeneScope insurance liaisons are able to walk individuals through foundational elements such as:

• The enrollment process
• Actual benefit and limitations of their particular policy or coverage
• Understanding the need for and the process to obtain prior authorization for specific procedures
• Discussion of referrals for specialized care and the member's responsibilities
• Discussing the ramifications of seeking health care services from "out of network" providers
• Discussion of member's out of pocket responsibilities
• Assisting with understanding changes in coverage when they occur

Our liaisons can ensure that the  industry language and legalese which  often accompanies insurance policy information is clarified and that members are able to understand, up front, how  best to proceed.  This allows the member to actually take charge of their health care to a far greater extent than when they are attempting to find their way without guidance or a light on the path.