FAQ- Employers

Why should we hire someone to handle advocacy issues for our employees? Isn’t this something our HR Department should handle?

Not any more. In light of the HIPAA Privacy Regulations, employers face a much greater liability risk if they continue to handle such issues, not to mention all the record and documentation requirements that are mandated in doing so. What’s more, employees prefer an outside source for handling plan issues. MAM’s Advocacy Services provide the help and expertise employees need to remain productive and happy with your health plan while allowing your HR Department more time to focus on the core competencies of your company.

Why don’t we just tell the employees they are on their own to handle health plan issues?

Employees would then need to spend more time during work (your dollar) to make the necessary calls to get the answers to their questions or help with their issues. This translates into a loss in company productivity, not to mention the increased frustration level many employees will endure. Also, as the plan sponsor, you have a fiduciary duty under ERISA to ensure that the plan is administered and communicated properly to all the employees.

Aren’t these issues our TPA should handle?

Unfortunately, the majority of the time, the TPA/Insurer is viewed by your employees as the “bad guy” who does not want to pay their claim, so even if a claim pays correctly, employees can still feel cheated. MAM helps your employees understand the plan and the claims payment system. Additionally we can deliver the “bad news” more easily, informing an employee that a bill truly is theirs to pay and why. A majority of claims are denied due to provider error and must be researched to determine the cause of the problem. Employees do not always understand this, and incorrectly blame the plan. MAM works with the providers to ensure they code claims correctly and are properly adjusting all the contractual write-offs.
The result? Everyone is happy!

We don’t have that many issues with our plans, so why do we need your services?

We hear this a lot, but employers are amazed when they see the actual utilization rates for using the service. Many employees feel intimidated and embarrassed discussing their medical condition(s) with their employer. We have found that there is a much higher utilization rate than expected when we contract with employer groups. Employees quickly view us as their confidential and trusted advocate. Our reporting reflects the types of calls we receive, and the types of questions and issues we handle, all while maintaining employee confidentiality. In addition, we work with you to price our services based on the projected utilization.

Do you assist just our employees, or will you also help their enrolled dependents?

We will assist everyone that is enrolled in your health plans including all employees and their family members.

What if we have employees in other states?

This is not a problem. MAM presently assists clients all over the country. Employees have a toll-free number to call, and receive assistance from a professional benefits representative until their issue is resolved.

Sounds great, but how much does it cost?

That all depends on how you want to pay for it! Typically, we charge a per employee per month fee based on the number of employees enrolled, and the types of plans you offer. Some employers include the fee as part of the plan administration costs and pass it on to the employee, which means that you are paying very little if anything for the many benefits MAM provides.

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FAQ – Plan Administrators

Our Customer Services reps are trained to handle benefit calls, aren’t you an unnecessary step?

Absolutely not. We hate to tell you, but you are viewed as the “bad guy” by the plan member and even if you paid the claim correctly, many times the member still believes they are being cheated. MAM knows that many claims get denied due to provider errors or eligibility errors that are not your fault, but the member still blames you. A large majority of the calls we receive start out with the caller saying, “This plan stinks. It did not pay my bill.” As we look further, we find that it is the member’s co-insurance to pay, or that it is a contractual write-off the provider has failed to make. We are quick to explain the real situation, help with the problem, and defend your actions. In other words, we make your product look great!

We like what we hear, but the addition of your services will just raise the administration costs for the plan.

Not necessarily. HIPAA is forcing many employers to stop assisting employees with health plan issues. Surveys show that employees want an independent place to turn to for help, as they are increasingly suspect of what they are told at the customer service level. You can now provide the “Independent Source” employers and employees desire as part of your plans administration package. Plus, MAM’s staff works very well with your personnel. In fact, we are happy to provide you with names of other plan personnel that love working with MAM. We don’t yell, we are objective, we speak your language, and we do a lot of the legwork. Your employees will spend less time with issues, so you actually end up saving money.

Okay, we’re sold, but can you provide the services under our name?

Yes. We have ghosting arrangements with other clients.

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FAQ – Brokers

Our service reps already help our clients with problems. So what do your services offer us?

There are a number of reasons our services can bring value to your brokerage services and more importantly make you money. Thanks to HIPAA, restrictions make it more difficult to work with your client’s HR Representative, which means you will have to assume greater responsibility for resolving member issues. Additionally, you are mandated to document and retain records for everything pertaining to plan advocacy. Not only do we handle plan issues, but we are also a confidential source for employees to call with plan questions and provider billing problems.

We agree that your advocacy services would make our plan designs and offerings look great, but the client expects us to handle problems and issues with the plan. How do we overcome this?

We find that when explained to employers that we are partnering with the broker to provide our services, employers are more than thrilled. If you have a large enough group or have a collective number of clients that meet our minimum requirements, we can look at ghosting the service for you.

Will you pay us a referral fee or do you expect us to pay MAM?

We are currently working under both arrangements, and will work with you to decide what works best for your agency and your clients.

Our employer clients are mainly small groups with less than 50 employees. Can you provide services to them?

Yes. You may want to consider becoming a distribution partner for MAM, and offer this service to all your clients. We will provide you the marketing material and enrollment information and show you how to make money doing so.

What if we have clients that have employees in other parts of the country or with numerous offices?

This is not a problem. MAM presently assists clients all over the country. Employees have a toll-free number to call, and receive assistance from a professional benefits representative until their issue is resolved.

We are not an insurance agency or broker, but see where your services would be a great benefit to add to our current list of client offerings. Can we offer your services?

Of course! We can set you up as a distribution partner, or work with you under a number of arrangements. Just give us a call.

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