Client & Employee Advocacy
Navigating the landscape of medical benefits and healthcare options
can be a daunting task for both employers and employees.
At Potomac Companies, we work closely with our clients and their insured staff to explain health care options on a one-on-one basis. We serve as your advocate and take on the responsibility of investigating and resolving all claim, eligibility, and carrier-related issues.
Potomac Companies’ skilled employee benefits experts work closely with your organization to simplify the health care process through proper benefits review, planning, and implementation.
Exceptions
There is no perfect insurance company. A client had an employee who was diagnosed with breast cancer. During chemo, she experienced hair loss and needed a wig. The insurance company denied the claim. With Potomac's advocacy, the insurance company issued payment for the wig.
Appeals
Client had an employee whose spouse struggled with mental illness. Spouse had suicidal and violent tendencies and was admitted to a mental health facility. Insurance company approved 12 out of 28 allowed days for their stay. Potomac appealed to the state insurance ombudsman and obtained approval for the full 28-day stay (prior to ACA reform).
Interventions
A client's employee had issues with the psychiatric practice she selected from their carrier's provider directory; one provider left the company, another refused to see her after one visit. This resulted in the employee having a negative impression of the carrier's service. Her recent bout with breast cancer triggered aftershocks of childhood abuse, resulting in the potential to cause harm to self or others. Potomac spent several weeks advocating for her on an escalated level, including a team of eight: top management within the carrier, the husband and wife, and the Potomac team. We successfully located a psychiatrist who met her provider criteria, removing the negative impression she previously had, allowing her to work together with her doctor for a successful treatment of her specific needs.
