When facing a healthcare issue, people confront a complex web of questions and decisions. What do their symptoms mean? Are they likely to subside, should they see a doctor soon or do they need emergency help? If they need care, how will they locate a network provider? How can they effectively manage benefits and claims issues? As healthcare complexities continue to grow, so too does the need for support when facing these important decisions.
Carewise Health Advocacy helps members become better consumers of healthcare and active participants in their care. We provide a set of services for convenient help in the areas of:
What is clinical advocacy?
Much more than a ‘nurse line’
Carewise pioneered the “nurse line” approach to helping members in 1983. Over the years, we have created a complete demand-management service that features the exact, powerful steps that we know are effective in helping members sustain better health over the long term. Unlike the basic nurse lines offered by some health plans, Carewise Health Advocacy goes far beyond symptom triage. Certainly, when a member calls the 24-hour, toll-free number, the health coach helps members decide what level of care they need and when. But the Carewise Health coach also follows up with the member later to ensure all needs are met. In addition to health information, the coach provides guidance in self-care and assists with decision-making about procedures, tests or treatments the member may be considering. Members learn how to actively participate in care and engage their providers.
After addressing the immediate need, the health coach is able to look at the member’s health profile including the member’s health status, their risks, and medical history. If a member has health risks but is not engaged in an appropriate program, the coach is able to enroll the member into a health coaching program. Members often are highly motivated to change behaviors immediately after seeking help from Health Advocacy, so they frequently agree to participate. The coach doesn’t just give the member a phone number to call. The coach keeps the member on the phone and places a call to the appropriate resource, facilitating a three-way call that builds on the member’s momentum.
The coach encourages wellness and prevention with individualized reminders about recommended check-ups, upcoming employer health fairs or incentives, and lifestyle tips, as appropriate. If members have questions about new medical treatments, they can even tap our medical librarian for research assistance.
What is navigational advocacy?
Finding the help members need
Carewise Health Advocacy helps members navigate what is often a confusing healthcare environment. Coaches educate and build awareness of the options and resources that are available. They connect members with the appropriate in-network provider, health plan resource, health improvement program or outside resources that can help.
Coaches never just hand out a contact phone number. The coach keeps the member on the phone and places a call to the appropriate resource, facilitating a three-way call that builds the member’s confidence and self-management skills.
What is benefit and claims advocacy?
On the member’s side, saving time and helping to solve problems
When members have questions about their health benefits, Carewise Health Advocacy can help them understand their plan and how to best utilize it.
When there are benefit or claims issues, Carewise Health assists members in solving problems while teaching them how to resolve issues themselves. For this reason, the coach always keeps the member on the phone while pursuing a resolution. Together, they may contact the provider’s billing office, the employer’s HR department or the health plan. With the coach’s help, the member either solves the problem or comes to a better understanding of the outcome. This service eases the member’s burden, saves valuable time, and the member is better prepared to prevent or address issues in the future.
Do you provide services in multiple languages?
Yes, 145 of them
When non-English-speaking members call for a Health Advocacy coach, they have the option of using our language line. An on-phone translator ensures members speaking almost any language have access to our full range of advocacy services.
