Just yesterday…We contacted one member with claims for diabetes, kidney disease, lipid disorder and hypertension. She was told about the program and the special benefits that were available. She said she was interested but she was concerned because her insurance company had already rejected claims from her eye doctor. We learned that she had diabetic retinal disease and she was having great difficulty with her vision. Her ophthalmologist had sent her a certified letter about how serious in need of treatment her condition was.
She was frightened and worried. We told her we would contact the insurance company and clarify the problem. Later that day the claims manager assured us that only a technical issue would’ve caused non-payment. The following day the patient called and we told her the good news that she could see her eye doctor and get the care that she needed immediately.
And, by enrolling in Pro Health Advisor program there would be no co-pay or deductibles required for treatment or medications related to her diabetes. She was greatly relieved and already a great believer in Pro Health Advisor. Pro Health Advisor is a innovative, multidisciplinary disease management program that focused on members with serious medical problems who need help.
Besides expert guidance and coaching, PHA solves problems and remove barriers to good health care.