Consulting Path-

Review and discuss healthcare needs and insurance coverage. Identify issues related to current or future coverage.

Example: Meg and Bob are living in London, but their three children are in the United States.: 19 year old college student and a 22 and 25 year old, both without employer benefits.  Bob’s employer healthcare plan only offers coverage in the U.K.  HCPathfinder researches coverage options in the U.S. and enrolls all the children in individual insurance plans, two plans in CT and one in S.C.

Example: Joe, 63, is retiring from his job. He will not be eligible for Medicare for another two years. In the meantime, he needs advice on his healthcare options until he turns 65 and becomes eligible for Medicare.  He also wants to understand what he must do to enroll in Medicare when the time comes. HCPathfinder helps Joe find and enroll in an individual health plan less expensive than the COBRA alternative, and prepares him for when he is eligible for Medicare.

Example: Walter and Anne are both turning 65 and want help understanding Medicare and signing up for coverage.  HCPathfinder helps them enroll in Medicare Part A & B. HCPathfinder also researches, finds, and enrolls them in a Part D, prescription drug, plan and a Medicare Supplement plan that is the best and most cost effective for their medical needs.  HCPathfinder makes sure they receive their new ID cards and then they continue employing HCPathfinder on the Pathfinder Path*.

Insurance Resolution Path

Advice and advocacy for a current healthcare or health insurance issues.  Negotiate bills and Appeal claims for services denied.

Example: Bill went to the Cleveland Clinic in Arizona for treatment because his insurance card indicated that his plan was part of a national healthcare network.  His insurance company denied the treatment saying that his company no longer had access to the national network.  HCPathfinder successfully appeals the denial and Bob’s treatment is covered by his insurance company because they failed to properly notify him that his coverage had changed. HCPathfinder saved Bill $15,000 and allowed him access to the care he needed.

Example: Jeff’s wife, Betty, had a major accident that resulted in many insurance claims and bills.  Jeff needs help managing the claims, the provider bills, and submitting claims for out of network care.  HCPathfinder manages the insurance paperwork and provides healthcare and health insurance support so that Jeff can focus on caring for his wife.  After Betty recovered, they took the Pathfinder Path* for ongoing management and support of their healthcare needs.

Case Management Path

Care and Insurance advice and advocacy. Facilitates transitions to inpatient facilities or outpatient care. Intervention with medical personnel and care providers. May also include relocation advice and services.

Example: Jane lives in Connecticut. Her father, Bill, who lives in Florida, fell and broke his pelvis and couldn’t go home from the hospital.  Her family needed someone to help them understand Bill’s discharge options and insurance coverage.  HCPathfinder was able to work with the hospital care management team and billing department to make sure that Bill received the care he needed and deserved, had a safe discharge plan, and his Medicare and retiree benefits were understood and maximized.

Example: Jean is in a skilled nursing facility (SNF) after she had hip surgery because she has two sets of stairs in her home and was unable to navigate her home safely. The discharge planner tells Jean and her family that she will be discharged in two days; however, Jean is still having trouble climbing stairs. HCPathfinder advocates on Jean’s behalf and works with the care management team. Jean gets approval to stay at the SNF for another week and a safe plan is developed for her go home.

Pathfinder Path*

Dedicated client service.  Client retains HCPathfinder annually to keep all healthcare information on file and be available to assist with all healthcare and insurance needs.  The client provides HCPathfinder with access to all health insurance benefit information and signs authorizations for HCPathfinder to speak to insurance companies, healthcare providers and other designated persons/professionals as needed.  An annual review of all client healthcare coverage is provided. Additional fees are billed for additional hours and services.

Example: *Walter & Anne sign up for these services after HCPathfinder helped them enroll in new insurance plans.  After the enrollments, HCPathfinder keeps all of their insurance information on file so that HCPathinder is available to help them with any problems or questions they have with their healthcare and/or health insurance. In the future, They enjoy having a professional to call who knows their coverage and can help them if they have any questions or problems.  Their children also have HCPathfinder available to help them if they need assistance managing their parent’s healthcare and insurance or their own.

Example: *Jeff & Betty sign up the entire family for these services to maintain and ongoing relationship due to their complex healthcare needs and large volume of insurance bills and claims.  They rely on HCPathfinder to manage all of their healthcare and health insurance needs. Throughout the year, claims are filed with insurance companies and are questioned, negotiated or disputed if necessary.  If requested, end of year statements are created for accounting purposes.