Health Advocate

Health Advocate, Inc. is a US national health advocacy, patient advocacy and assistance company, serving more than 12,800 clients and 40+ million people and offering a spectrum of services to help employers, employees and consumers navigate the healthcare system and facilitate members’ interactions with insurers and providers. The privately held company was founded in 2001 by former Aetna executives and is headquartered in Plymouth Meeting, Pennsylvania. The company employs registered nurses, medical directors and benefits specialists who address a range of health care and health insurance issues. Personal Health Advocates can help members locate providers, address errors on medical bills, answer questions about coverage denials and assist with insurance appeals.

The company's products include Wellness Advocate, Benefits Gateway+Health Information Dashboards, EAP and Worklife, Pricing Decision Support, Personalized Health Communications, Chronic Care Management, and HR solutions. The company offers a direct-to-consumer advocacy service, called Health Proponent to individuals who are not part of groups.

Core advocacy

Clinical Assistance helps members understand tests, treatments, and medications recommended or prescribed by physicians, facilitating the transfer of medical records, X-rays, and lab results before a scheduled appointment with a new physician, arranging for home-care equipment after discharge from a hospital, facilitating review of test results with another physician for confirmation of diagnosis, consolidating a multiple-day testing schedule for members with special needs, arranging hospice and other services for the terminally ill, facilitating transfer from a community hospital to a tertiary care facility.

For example: Researching a member’s outstanding out-of-pocket responsibilities and resolving errors with providers and/or the member’s health plan, correcting balance-billing problems, correcting charges incorrectly applied to the member’s deductible, resolving eligibility problems and benefit and claim denials, coordinating benefits between dental, medical, worker’s compensation, and disability carriers, assuring correct application of provider network status, correcting errors in processing of “blind” network provider discounts, resolving coordination-of-benefits disputes between carriers, satisfying plan requests for copies of referrals, providing correct member insurance information to providers.