HIGH-COST CLAIMS MANAGEMENT
We can help.
Our advisory team of physicians and specialized clinicians will reach out to your member, family/caregivers, doctors and pharmacists, as soon as a serious diagnosis is known. They will help your members understand their situation and navigate the healthcare system. Their goal is to help your members to:
- Understand their diagnosis and treatment options
- Choose and comply with optimal treatment plans
- Find high quality providers and coordinate care
- Avoid poor quality care and unnecessary tests and procedures
- Mitigate disease progression
- Understand medical bills and obtain financial assistance, if available
- advocate for the patient and family as a liaison with their doctors, if needed
The team will remain engaged and work with your members and their care teams during the course of the condition.
The ROI is twofold:
- Your employees will be more productive and satisfied because they will not be distracted with the complexities of navigating their healthcare journey on their own.
- Your claims cost will be lower if optimal care is introduced as early as possible.
Our medical advisory team is independent of the hospital systems and is not biased by financial incentives. They work for you and your members to optimize care, guiding your members to the right care, in the right place, at the right price.
When your employee is diagnosed with a serious health condition, the chaos begins. Your employee must become an expert at treatment options, coordination of care, and cost, all while dealing with the emotion, fear, and potential poor health that come with a serious diagnosis.
Start With a Governance & Risk Diagnostic
A focused 20-minute conversation will quickly show whether your health plan has the governance,
financial controls, and vendor accountability your organization needs — or where the gaps are.
What you’ll receive:
- A brief review of your current governance structure, pharmacy oversight, and financial monitoring
- A preliminary assessment of risk, waste, or misalignment in your plan design, vendors, and contracts
- Clear next steps to strengthen performance, reduce volatility, and protect your organization
No pressure. No obligations. Just clear visibility into how your plan is being run.
Prefer email? Contact us at info@allypartners.net