Is Your Medical Benefits Advocate Conflicted?

Is Your Medical Benefits Advocate Conflicted?

Companies are relying on advocates from their insurance company to get employee medical bills approved and paid. This is bad news for employees, as in-house human resource positions are removed and the people who are fighting for bills to be approved are conflicted by their true employer… the insurance company. Read more about this conflict of interest and how a third party advocate can save companies and employees money by getting medical bills covered by appropriate parties.

 

Who Advocates for Your Medical Benefits?

A couple of weeks ago, I read about a man who stayed with an employer because of his Human Resources Medical Benefits Advocate. The advocate knew the ins and outs of the medical benefits contracts the employees had with the medical insurance provider and when an employee was seeking medical care and needed the insurance company to pay for it the advocate would assist getting all of the paperwork together from the necessary parties and ensured that bills were being paid.

Too often, employers are now relying on the advocate provided by the insurance company to represent their employees. The issue with an employee of the insurance company being the sole representative of the insured is the underlying conflict of interest in the position. The employee of the insurance company, has a duty to act within the best interest of the insurance company, instead of acting in the best interest of the insured. Therefore, coverage is being requested and denied by the same business entity and the rights of all contracting parties are not truly represented.

Further, nothing is stopping an insurance company from requesting employers require employees to rely on the sole representation of the insurance company’s representatives to seek and appeal for coverage in exchange for a lower rate. This is a flawed agreement. This creates an appeal system with no outside oversight. I urge employers to carefully review the agreements they are entering and offering their employees. The only way to avoid these types of clauses is to seek outside representation to review the contracts and advocate for the rights of your employees.

Negotiating the medical coverage of employees and ourselves cannot be something that the government, employers or insurance companies are left to understand and discuss alone. The insured must be protected. If a service is not covered the insured are the ones who are stuck with the bill and paying out of pocket. As consumers of medical services and insurance policies we should be aware of ways to lower medical bills.

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