Employee benefits advocacy is direct help for employees with claims, bills and coverage problems, from someone who knows their plan and can work with the carrier on their behalf.
What employees call about
- Denied or confusing claims
- Medical bills that look wrong
- Prior authorizations that stall
- Missing or incorrect ID cards
- Coverage and policy questions
- Problems at the pharmacy counter
Why this matters to HR
When an employee gets a bill they don't understand, they usually walk it to HR. Then someone in HR spends an afternoon on hold with a carrier. Giving employees a direct line to PAKG, all year, takes that afternoon back.
What we can and can't do
We can find out why a claim was denied, get coding errors corrected, push a stuck authorization and help an employee file an appeal. We know the carriers, and often we know who to call.
We can't change what a plan covers or promise every denial gets reversed. When the answer is no, we explain why in a way that makes sense.
Privacy
Health questions stay between the employee and us. HR hears about trends that affect the plan, not about anyone's medical situation.
How a case moves
- They reach out
- By phone or email, without going through HR first.
- We look into it
- We read the claim or bill, check it against the plan and find what went wrong.
- We work it
- Calls to the carrier, the provider or the pharmacy, until there's an answer.
- We follow up
- The employee hears back from us. HR hears about patterns, not every case.