We work with you to provide clinically based insights to resolve complex insurance claim denials
For select cases, PHM can apply its deep clinical expertise and knowledge of the latest treatments/tests available in medicine to advise during the appeals process.
Advise on Coverage Decisions
Provide employer/employee with an unbiased and trusted clinically capable team who can advise on whether the denied treatment is rational. This can lead directly to a discrete coverage decision.
Suggest Potential Alternative Therapeutic Options
Provide employer/employee with science-backed, clinically robust perspectives on whether the treatments being contemplated are worth pursuing and/or if there are other potentially more effective alternative therapeutic options.
Provide Administrative Relief
Extract benefits leaders and team from a process where they do not possess the requisite clinical capability or expertise.
Foster Positive Employee Relations
Demonstrate to employees that the company is working on their behalf – providing timely access to a trusted team to help educate and guide them as they navigate the complex healthcare ecosystem.
Identify Patterns in Employee Health Needs
Investigate opportunities for systemically addressing cost and quality gaps.
We bring a unique combination of science, risk management, and health and business operations knowledge to deliver integrated insights to company’s pressing health risk issues.