Customer Service

Anger, Frustration to “I Can Sleep Tonight” Navigating to a Better Outcome 

She let me know how extremely grateful she was for the help navigating this issue during her pregnancy.

The Story 

At Echelon Group, the relationships we build with our clients are just as important as the services we provide. Day to day, our goal is to improve the well-being of employees, their families, and our community. One of the ways we accomplish this is by proactively working to solve individual employee healthcare challenges, removing friction, and helping our client’s employees feel at ease about their options. One day, I received an email from our client about an employee’s spouse (a participant in the healthcare plan) who was pregnant with her second child and enrolled in the company health insurance plan. ​ This plan participant, when on a previous plan through a different employer, had a negative experience with the birth of her first child that ended in the hospital paying a settlement after the birth. She was adamant that she would not use that hospital for her second child and wanted to make sure the policy covered providers and facilities outside of her network. When the plan participant was in the office of her healthcare provider, she learned that her new maternity benefits were more limited than she had previously understood with regard to options outside of the hospital where she had delivered her first child. She felt frustrated, did not know what to do next, and began to worry not only about the cost of going out of network, but also about the safety of her unborn child after her first experience with the hospital. ​ Upon learning of this information, I contacted the health insurance carrier to discuss the unique situation and possible solutions. In working with the health insurance carrier representative, we identified several options for the plan participant including a potential one-time exception for labor/delivery and newborn care at an out-of-network facility that would still be within network benefits.

In challenging situations, it’s important to have a pro-active problem solver to facilitate communication between employees and carriers, and a benefit broker is the assistance every company needs along the way.

The Results 

During this time, I kept in contact with the plan participant to provide updates and let her know that the process was taking time, but progress was being made. She was so appreciative of the efforts and told me she already felt a large sense of relief. ​ After a few days, I learned that the plan participant had been denied the one-time exception. The health insurance carrier felt that there was sufficient provider coverage in the area that the member could access. They offered additional solutions including the provider becoming a part of the network. I was able to connect the health insurance carrier representative and the plan participant, and together they continued to work towards a solution. ​ The following week, I called the plan participant to check in on the progress with the carrier. While they were still working through some details, she let me know how extremely grateful she was for the help navigating this issue during her pregnancy. Although this was a difficult and unique situation, we were able to be by her side, navigate her through the process, and successfully assist her along the way to a better outcome for her and her family. This example illustrates the communication facilitation and pro-active problem solving that we provide every day to our employer partners and their employees.

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Email Us Schedule a Meeting 208.345.9944

Connect with our team!

Email Us Schedule a Meeting 208.345.9944