Health Advocates

 

The Faculty Association of Suffolk Community College Benefit Fund has retained the services of Health Advocate, Inc. to provide a Program designed to help you and your families handle healthcare and insurance related issues by cutting through the red tape and barriers that so often create frustration and problems.

 

Who is covered

Health Advocate will provide services to all eligible, full-time, active members of the  Benefit Fund, retired members of the FASCC who enroll in and pay for one of the enhanced self-pay retiree plans of the Fund, as well as the Active and/or Retired Member's spouse/domestic partner, dependent children, parents and parents-in-law (collectively referred to in this section as "Eligible Members").

 

What are the benefits

Health Advocate will help you and your families make more informed decisions about health care. A Health Advocate nurse will answer your questions, do the research, provide you the options and follow up with you.

The following services are provided to Eligible Members:

The Personal Health Advocate is typically a Registered Nurse, assigned to serve the subscriber as soon as he/she calls to access Services.  Personal Health Advocates handle a range of issues as Eligible Members seek healthcare services and interact with providers and insurers. 

  • 24/7 HelpNet: Health Advocate's business hours for reaching a live person are 8:00 a.m. to 7:00 p.m. Eastern Standard Time.  After hours, Eligible Members can leave a message and Health Advocate will return the call the next business day.  In a non-medical emergency, Eligible Members may use the beeper number provided to page an "on-call" Health Advocate representative.
  • Care Coordination: The Personal Health Advocate helps Eligible Members coordinate care among physicians and medical institutions.
  • Medical Director and Administrative Support: Physicians and administrative staff support the Personal Health Advocates.

 

Benefits Advantage™

  • Claims Assistance: Personal Health Advocates help sort out and solve claims and related paperwork problems and assist Eligible Members with coverage and benefits issues.
  • Fee Negotiation:  When necessary, Health Advocate can attempt to negotiate fees with healthcare providers and review questionable bills to catch duplicative and/or erroneous charges.
  • Grievance Advice:  Health Advocate will provide advice and/or assistance to Subscribers when filing a complaint or grievance.  However, any costs and expenses incurred by Health Advocate in connection with representation at appeals hearings will be billed directly to the Eligible Member, at an hourly rate. 
  • Coverage Advantage™:  The Personal Health Advocate can help Eligible Members through the coverage review process.  We can also assist in identifying alternative coverage options when necessary.
  • RxAdvocate™:  The Personal Health Advocate can assist Eligible Members with prescription drug issues including formulary and benefit questions. 

 

Physician Locator: 

Personal Health Advocates can help Eligible Members identify physicians, hospitals, dentists and other healthcare providers for needed services.

 

Advocates of Excellence:

Personal Health Advocates can help identify top medical institutions, Centers of Excellence and medical providers to assist Eligible Members in need of complex medical care. Our Personal Health Advocates can also help Eligible Members schedule appointments with these providers, as required.

 

Health Advocate CareQuest:

This Service locates resources and makes arrangements for Eligible Members in need of special services that typically fall outside the realm of traditional healthcare benefits. The Eligible Member is responsible for payment for any services that they use beyond what may be covered by their health insurance plan.
Health Advocate does not deliver medical care nor tell Eligible Members what to do. Health Advocate does not replace the Employee Benefit Unit (EBU) in Suffolk County, customer service through Empire Blue Cross/Blue Shield or your HMO provider, nor is it a nurse hot-line for emergencies.

 

How are benefits obtained

Simply call Health Advocate at 1-866-695-8622. There are no enrollment forms. When you call, Health Advocate and require service, they will ask you to complete a Medical Information Release Form. Please be assured that all your information will be kept strictly confidential by Health Advocate and your privacy will be protected