Advocacy in Action | Help Understanding Coverage

A member’s wife was having a baby. She had already had several prenatal visits, and the member was calling to see if a birthing center they planned to use would be covered under their medical insurance plan. The member also had questions about a supplemental medical gap plan (medical gap insurance helps cover out-of-pocket expenses). He wanted to understand how the medical gap plan worked with his medical insurance plan. The Patient Advocate checked into the birthing center and determined it was an in-network service provider under the medical insurance plan. She then explained the medical gap plan coverage and how it works. She let the member know the medical gap plan covers the co-insurance and deductibles for eligible expenses left over once the claim processes under the medical insurance plan. If the member had not presented his medical gap insurance ID card at the time of service, then the claim would need to be filed directly with the medical gap plan, and the Patient Advocate could assist with this process. To begin the process, the member would need to gather and provide copies of the explanation of benefits (EOB’s) from the insurance carrier and itemized statements from the service providers. Here is what the member had to say about the Purple Card service he received:

“I really appreciate your help! You have gone above and beyond.”

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At Brinson Benefits, we care about the patient’s best interest. We believe the patient should have an available healthcare navigator and advocate. Our Patient Advocates at The Purple Card® are highly trained to educate members about available benefit programs. They work hard to resolve issues with providers and insurers.

The Purple Card® is an independent health care advocacy and assistance service. Our Patient Advocates provide time and cost-saving services to resolve concerns about benefits programs. We not only assist our members, but we also educate them on ways to maximize health care coverage and other available benefit programs.