Answers to your Questions about Employee Benefits

Posted in: Employee Benefits

Building the right employee benefits program and managing it well can be a crucial factor in employee morale and retention. Unfortunately, not all benefits broker firms/consultants provide the same level of service. One of the critical services you should look for when choosing a benefits broker is Employee Advocacy. In this post, we hope to provide answers to your questions about employee benefits.

What is employee advocacy?

Employee Advocacy normally consists of access to a team of experts dedicated to solving any questions about employee benefits and day-to-day issues that may arise in your benefits plan. They commonly address issues such as claims and benefit questions. In some cases they will provide open enrollment assistance and coverage information. Not all benefits brokers offer this service. They simply direct employees to contact the insurance carrier directly to resolve the above-mentioned issues.

The benefits associated with an insurance broker that offers dedicated client advocacy include:

Lighten your team’s administrative burden

Take the burden of handling the daily ins and outs of employee benefits off your shoulders, saving time for your HR department, management team, and employees. The right benefits broker can take care of any questions about employee benefits.

Quick issue resolution

Brokers with Employee Advocacy teams normally provide a direct line for your employees to call when they need support, allowing your people to bypass the long wait-times of 1-800 numbers that you can find on the back of insurance cards. As opposed to calling the carrier directly where employees will probably get a new person each time when following up on an issue, Employee Advocacy groups establish one point of contact who can manage the issue at hand through resolution.

Normally, a good advocacy team maintains direct working relationships with the insurance provider’s staff, enabling the team to get answers and solve problems faster.

This is very beneficial because employees may be searching for healthcare questions and answers and if they aren’t receiving solutions fast, their frustration could lead to disgruntled employees.

Avoid headaches for your employees

A good client advocacy team will act as a conduit and champion when dealing with medical, dental, or vision insurance claims. And when an insurance claim gets complicated or an unpaid bill is headed for collection, the team can step in and help the employee resolve a small issue before it becomes bigger.

Likewise, this is an added perk that goes a long way toward engendering loyalty and satisfaction among your employees. All of these “client services” add up and can make a real difference in your company’s overall experience — and how your employees perceive their benefits (and in turn, your company).

Here are some “real world” examples of the work our team at PSA manages on a day-to-day basis:

Responding to service coverage questions

Some of the most common inquiries involve questions about whether a person has coverage for chiropractic, acupuncture, or dental implant services. While most insurance advisors might be able to handle these questions, they should also be able to address more complicated and unique situations and be aware of any updates or changes in coverage. For instance, if a client needs a less-than-common treatment, such as hyperbaric oxygen therapy, he or she might find that it’s not listed in his coverage. An advocacy team can find out if the therapy is covered and to what extent, and whether there are any in-network providers in the area.

Verifying benefits eligibility

No insurance – Hospitals all too often tell new parents that their babies are automatically added to the parent’s health insurance. However, in reality, babies are typically only covered under their mothers’ insurance for 30 days from birth, and the mother still has the responsibility to add the newborn to her policy to ensure coverage beyond the first 30 days. If, for instance, a newborn needs emergency surgery but has not been added to her mother’s policy due to misinformation at the hospital, a client advocacy team can get the baby added to the mother’s plan and have the procedure quickly authorized by the carrier.

Terminated coverage – A simple typo when enrolling in health benefits can cause insurance companies to terminate your coverage. If this happens, your client service team can call the carrier to correct the typo and have the client reinstated.

Using an old insurance card – Often, people mistakenly provide their old insurance cards to their healthcare providers, which can also result in denied service or coverage. A good benefits team can step in and sort out the issue, ensuring the customer is not erroneously charged for items or treatments covered under his or her insurance.

Claims Advocacy

Managing claims can be as easy as correcting a date on a bill to ensure payment for a service, or it can be much more complex and involve researching in-network providers for a sick child who needs medical attention on a cruise ship in the Caribbean. If a member is on vacation in a foreign country and obtains medical treatment, the bill received by the insurance company is often in a foreign language, causing a potential delay or even a denial of the claim. This is another scenario in which a high-quality client advocacy team goes the extra mile, even if it means finding someone to translate the bill.

Why is employee advocacy important?

Employees are one of every organization’s biggest and most important asset and should be treated accordingly. Without a strong workforce made up of healthy, happy employees, company culture and morale suffer. This makes it important to not only offer employee benefits, but ensure your benefits broker is advocating for your organization’s front line.

Peace of mind is one of the most important things you can secure for your company and your employees — peace of mind that you’re providing not just high-quality benefits for your workforce but also high-quality benefits management. Having an advocate in place gives your employees a sense of comfort that they and their families are cared for by a trustworthy partner.

If your employees feel like they’re up against an insurance obstacle they can’t overcome, a good Client Advocacy Team will step in and help.

At PSA, our award-winning Employee Benefits division and client services team put the well-being and interests of your company — and each one of your employees — first. Please feel free to contact me at to learn more.

Related Posts

  1. IRS Updates Electronic Filing Requirements (Benefit Minute)
  2. PSA In Good Health 2023 Volume 6